Vital Signs Monitor

ABSTRACT

A multi-parametric vital signs monitoring device configured for use as an ambulatory and a bedside monitor wherein the device can be patient-wearable and is battery powered. The monitoring device can be used with a charging cradle to provide power to the device in lieu of the battery as a power source for bedside applications, in which the cradle further serves as an intermediary device to enable a data link with a PC or other peripheral device. The monitoring device can include a wireless radio to enable bi-directional transfer of patient-related data to a separate remote station.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of, and claims the priorityand benefit to, pending U.S. patent application Ser. No. 11/795,301,filed on Jul. 13, 2007, which is National Stage Entry ofPCT/US2006/001093, filed on Jan. 13, 2006, which claims priority fromU.S. Provisional Application 60/643,636, filed on Jan. 13, 2005. All ofthe aforementioned patent applications and patents are incorporatedherein by reference in their entirety.

FIELD OF THE INVENTION

The invention relates to the field of medical diagnostic instruments andin particular to a portable, battery powered, multi-parametric, vitalsigns monitoring device that can be used for both ambulatory andtransport applications as well as bedside monitoring. The device can beused with an optional charging cradle that supplies power and chargesthe contained battery. The charging cradle can additionally serve toprovide an isolated data link to an interconnected portable computerallowing snapshot and trended data from the monitoring device to beprinted automatically and also allowing default configuration settingsto be downloaded to the monitoring device. The monitoring device iscapable of use as a stand-alone unit as well as part of a bi-directionalwireless communications network that includes at least one remotemonitoring station.

BACKGROUND OF THE INVENTION

A number of vital signs monitoring devices are known that are capable ofmeasuring multiple physiologic parameters of a patient wherein varioussensor output signals are transmitted either wirelessly or by means of awired connection to at least one remote site, such as a centralmonitoring station. U.S. Pat. No. 5,319,363 describes a wired version ofsuch a device and network, while U.S. Pat. Nos. 6,544,173 and 6,544,174each describe a multi-parametric vital signs monitoring device that islinked by means of a bi-directional wireless communications network withat least one central monitoring station, usually located at a nurse'sstation on a hospital floor or Intensive Care Unit (ICU). Suchmonitoring systems have dramatically improved the manner in whichpatients can be monitored during a hospital stay. However, there is aperceived need in the field to provide a patient monitoring device thatis truly versatile, such that the device can be selectively used forbedside as well as ambulatory applications in order to more effectivelycover the varied number of situations a monitored patient may encounter,but without a loss in device (e.g., monitoring) connection with thatpatient or in obtaining required physiologic data.

There are additional concerns that exist in the field of patient vitalsigns monitoring. For example, the nature of monitoring devices thatcontinuously monitor SpO₂ (blood oxygen saturation) levels of a patientcan cause false or nuisance alarms, particularly those patients who areof lower acuity or are ambulatory. Traditional continuous monitors ofthis type are found in ICU, OR, ED, PACU and other specialty beds, forthe most part. The majority of hospital beds, on the other hand, arefound in medical-surgical and/or general care areas in whichnon-continuous, spot-checking monitoring devices are primarily used. Itis believed that present hospital healthcare dynamics, such as thegeneral shortage of nurses, has increased pressure for regulatorycompliance, rising costs, and higher acuity in patient census. Thelatter, it is further believed, could cause a convergence of continuousmonitoring and spot-checking to the un-monitored beds of the hospital. Avery large challenge or barrier to this trend is that clinical staffmembers on medical surgical floors are generally ill-trained oradequately skilled in the use of continuous medical monitoring devices.

There is yet another general need in the field of patient vital signsmonitoring to improve the level of alarm management with regard toexisting physiologic monitoring devices. Most known devices of this typeinclude at least one visual and/or audible alarm that is produced,typically both at the monitoring device (e.g., bedside) as well as atthe central monitoring station. According to one currently knownmonitoring system, the preset upper and lower alarm limits for allphysiologic parameters can be automatically changed simultaneously asingle time by a user simultaneously by a specified percentage (e.g., 20percent). While this form of management/updating is often suitable forcertain parameters, such as heart rate, it is not practicable for otherparameters (e.g., SpO₂). Though some monitoring devices further permitmanual adjustment of alarm limits, this adjustment can be a somewhattime consuming and tedious process. As a result, there is a generaldesire to improve alarm management over presently known patientmonitoring devices.

Additionally, there are also a number of patient monitoring devices thatcan indicate when an electrode assembly, such as those used for ECGelectrode assemblies, has already reached failure or has become detachedfrom the patient, such as those described by U.S. Pat. No. 5,819,741 toKarlsson et al. It would be even more desirable, however, to provide apatient monitoring device that can in addition to the above featuresproactively detect the onset of failure in at least oneleadwire/electrode such that the at least one electrode or leadwirecould be retrofitted in advance of having the ECG electrode assemblyfail during examination or during rounds.

It is a desirable function of any cardiac monitoring device to providesufficient information so that a clinician can discern if an implantedcardiac pacemaker is operating properly. Basically, it is desirable toinclude in the ECG waveform a highly visible indication each time thepacemaker fires. As the technology for implanted pacemakers andimplanted pacing electrodes has evolved, the magnitude and duration ofthe pulses that result at the body surface have reduced, making thesepulses more difficult to detect. Furthermore, the observed pacer pulseamplitude is smaller in some ECG vectors than in others. Which ECGvectors have the strongest pacer pulse signals is dependent on bodysurface ECG electrode placement and the location of the implantedpacemaker electrodes, and therefore the detection issues vary frompatient to patient. Making the pacer pulse detector in an ECG monitoringdevice be able to detect smaller amplitude, shorter duration spikesunfortunately causes the detector to trigger more often on theelectrical noise spikes that often occur in the patient's vicinity.Faulty incandescent light dimmers, fluorescent lights, electronic powersupplies, and other assemblies generate electromagnetic interference(EMI) and other sources of electronic noise may generate such noisespikes, these spikes occurring at a rate that is twice the frequency ofthe power line. If a pacer pulse detector is triggered this rapidly, itis extremely difficult for the monitoring device to calculate anaccurate heart rate. The extent to which these noise spikes affect apacer pulse detector is further affected by the contact impedance of thebody surface ECG electrodes—higher impedance connections make it morelikely that these noise spikes will trigger the pacer pulse detector.For each of the foregoing reasons it is therefore desirable to be ableto select as an input to a monitor's pacer detector, an ECG vector thatcontains real pacer pulses whose amplitude is sufficiently above thedetection threshold, and which also contains environmental noise spikeswhose amplitudes are sufficiently below the detection threshold. To thatend, it would be desirable to be able to identify localized areas orsources of electrical noise, in order to permit the clinician to movethe patient and/or noise source and thereby avoid instances of prematurealerts or other similar situations.

It is yet another general desire in the field of remote monitoring toprovide a multiple physiologic parameter monitoring device that is moreuser-friendly than previous devices of this type; that is, a device thatcan be more easily and effectively used by staff of varying skilllevels.

Still further, there is a general need to provide a more rugged anddurable patient monitoring device, given that such devices are findingincreased uses, for example, in military field applications, requiringdevices of this type to be much more tolerant to shock and environmentalloads than those found in classical hospital environments.

SUMMARY OF THE INVENTION

According to an aspect of the present invention, there is hereindescribed a portable, lightweight and battery powered vital signsmonitoring device that is capable of being used as an ambulatory ortransport monitor and which is optionally patient-wearable. In spite ofits lightweight design defined by a compact profile for ease oftransport and handheld use, the device is defined by a rugged designthat is intended to withstand shock, impact and/or other loads thatcould be present in literally any patient-related setting orapplication.

The herein-described monitoring device can also be used in connectionwith a charging cradle, permitting use of same as a bedside monitor,wherein the charging cradle provides power for the monitoring device inlieu of the contained battery and provides charging for same. Inaddition, the monitoring device and cradle further permit mounting ofsame, for example, to either a bed rail and/or a fluid (IV) pole, asneeded, or to a large display connected as a peripheral to the device asmounted in the cradle with the cradle having a data port permitting thepass through of data.

The monitoring device further optionally includes an integrated wirelesstransceiver and antenna, permitting communication bi-directionally withat least one remote station, such as a central monitoring station, overa wireless network. The monitoring device can operate to transmitpatient data whether the device is connected to the charging cradle orwhile in use as a stand-alone unit.

The charging cradle according to one aspect of the present inventionfurther can permit a data-link connection between the monitoring deviceand a portable computer (PC). According to one version of the invention,the PC can be equipped with configuration utility software and used inorder to custom configure the monitoring device for specified usage in ahospital or facility; for example, a neonatal ward. According to anotherversion, the monitoring device is storing “snapshot” data and trendeddata to be manually or automatically transmitted for printing using thePC with the connected charging cradle acting as an intermediary or passthrough device. Alternatively, the charging cradle permits themonitoring device to transmit patient data in a real-time fashion, suchas to a large display via the serial connection.

The monitoring device according to another aspect of the presentinvention is connectable to a plurality of physiologic sensor assemblieswherein multiple patient parameters can be measured, including, forexample, blood pressure, SpO₂, ECG, pulse/heart rate and respiration.The monitoring device includes an integrated display to indicate thestatus of the measured physiologic parameters, as well as a userinterface, including a keypad, that permits the user to selectivelydisplay various output or display modes, including both tabular andgraphical data trending of at least one monitored physiologic parameter,as well as to view status of the monitoring device, includingconnectivity with the wireless network, available power to operate themonitoring device, and other features.

According to yet another aspect of the present invention, the userinterface of the monitoring device permits navigation using a series ofembedded menus using the keypad (user interface), thereby minimizing thetime required for the clinician to obtain relevant data and furtherpermitting highly skilled as well as less skilled clinical staff toequally and effectively utilize the monitoring device. The devicefurther includes security features wherein the buttons of the userinterface and/or the display can be locked out or disabled in order toprevent any unauthorized use and power-saving features wherein thedisplay is automatically powered down based on a lack of activity or inwhich certain assemblies are made inoperative (i.e., NIBP) when a lowbattery condition exists. In addition and in a wireless version in whichthe herein described monitoring device is out of range, the wirelessdata transmission feature can selectively be deactivated until thedevice is again in range of the network.

According to still another version of the present invention, the userinterface is additionally configured to assist the user in terms ofalarm management. According to this version of the present invention,upper and/or lower alarm settings or limits for specified measuredparameters can be selectively incremented by preset percentage amounts,as needed, during the occurrence of an existing alarm. Additionally, allparameters can be similarly adjusted simultaneously, as needed.

According to yet another aspect of the present invention, the monitoringdevice permits continuous measurement of certain physiologic parameters,including pulse oximetry. The device, however, can be selectivelyconfigured by the user such that the remaining physiologic parameters,such as ECG, can continue to be monitored in the usual manner while SpO₂readings of a patient can be selectively random or spot checked by theuser of the monitoring device.

An advantage of the present invention is that a multi-parametricmonitoring device is provided that can be used in literally any patientsetting, allowing the device to be used for monitoring a patient onhospital medical-surgical, telemetry and intermediate floors, hospitalemergency departments, transport, emergency medical services and/orother health-care applications. As such, the herein described monitoringdevice can be used for and/or between bedside, ambulatory, transport orother similar applications seamlessly.

Moreover, the rugged construction, compact design and adaptabilitybetween various bedside and transport applications make the hereindescribed monitoring device extremely useful for military and othersimilar purposes.

Another advantage of the present invention is that the herein describedmonitoring device can be custom configured to enable the device to beused in a specific facility. The device can also be temporarilyconfigured for a current patient, wherein settings can be selectivelyretained for the patient or deleted along with stored data upon powerdown of the device, thereby facilitating use between patients.

These and other aspects, features and advantages will become readilyapparent from the following Detailed Description as well as theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a front view of a vital signs monitoring device in accordancewith an embodiment of the present invention;

FIG. 2 is a front perspective view of the vital signs monitoring deviceof FIG. 1;

FIG. 3 is a top plan view of the vital signs monitoring device of FIGS.1 and 2;

FIG. 4 is a front perspective view of a charging cradle that is used inconnection with the vital signs monitoring device of FIGS. 1-3;

FIG. 5 is a front view of the vital signs monitoring device of FIGS. 1-3as mounted in the charging cradle of FIG. 4;

FIG. 6 is a schematic block diagram of a patient monitoring systemincluding the vital signs monitoring device of FIGS. 1-3 and thecharging cradle of FIG. 4;

FIG. 7 is another front view of the vital signs monitoring device ofFIGS. 1-3 as mounted in the charging cradle of FIGS. 4 and 5,illustrating the user interface thereof;

FIG. 8 is a front view of the vital signs monitoring device of FIGS. 1-3with an attached strap permitting hand-held operation thereof;

FIG. 9 is a alternative view of the vital signs monitoring device ofFIGS. 1-3 using a patient-wearable harness;

FIG. 10 depicts the vital signs monitoring device of FIGS. 1-3, as usedin a patient transport application;

FIG. 11 depicts the vital signs monitoring device of FIGS. 1-3 asmounted to a bed rail and attached to a large display;

FIG. 12 depicts the vital signs monitoring device of FIG. 11 as attachedto a charging cradle and an interface housing for the large display;

FIG. 13 depicts the vital signs monitoring device of FIGS. 11 and 12 asmounted in a charging cradle and directly attached to the large display;

FIG. 14 illustrates two sample display screens indicative of theinformation that can be captured by the vital signs monitoring device ofFIGS. 1-3 and displayed by the large display;

FIG. 15 illustrates an example of a display screen of the vital signsmonitoring device of FIGS. 1-3 according to one display mode;

FIG. 16 depicts another example of a display screen of the vital signsmonitoring device according to another display mode for the vital signsmonitoring device of FIGS. 1-3;

FIG. 17 depicts yet another exemplary display screen according to yetanother display mode for the vital signs monitoring device of FIGS. 1-3;

FIG. 18 depicts yet another example of a display screen according to yetanother display mode for the vital signs monitoring device of FIGS. 1-3showing trended tabular data;

FIG. 19 depicts the toggling between various display modes using thevital signs monitoring device;

FIG. 20 illustrates another display screen showing how the displaycursor is used to highlight a displayed item to permit navigation;

FIG. 21 illustrates another example of a display screen of the vitalsigns monitoring device of the present invention and illustrating howthe SELECT button is used to select a highlighted item for navigation;

FIG. 22 is an exemplary control menu accessed through selection of thehighlighted item of the display screen of FIG. 21;

FIG. 23 depicts another exemplary control menu for the vital signsmonitoring device in accordance with the present invention;

FIG. 24 depicts side by side examples of display screens presented to auser of the vital signs monitoring device upon powering up of thedevice, depending upon whether patient-related data and settings havebeen previously stored by the device;

FIG. 25 is an exemplary set-up menu for the vital signs monitoringdevice;

FIG. 26 is an exemplary set of information display windows for the vitalsigns monitoring device;

FIG. 27 is a configured data display screen of the vital signsmonitoring device in which patient information is being entered;

FIG. 28 is another display screen depicting a patient information entrypanel of the display screen of FIG. 27;

FIG. 29 depicts an exemplary change patient mode menu for the displayscreen of the vital signs monitoring device of FIGS. 1-3;

FIG. 30 depicts a confirmation display screen that is displayed by thevital signs monitoring device in accordance with the invention when apatient mode is changed by the user;

FIG. 31 is an exemplary display screen of the vital signs monitoringdevice of the present invention including a time/date control menu;

FIG. 32 is an exemplary display screen of the vital signs monitoringdevice of the present invention including a waveform source menu;

FIG. 33 is another exemplary display screen of the vital signsmonitoring device depicting a different waveform source;

FIG. 34 is another exemplary display screen of the vital signsmonitoring device including a waveform size menu;

FIG. 35 is a display screen of the vital signs monitoring devicedepicting an ECG set-up menu in accordance with an aspect of the presentinvention;

FIG. 36 is another example of a function performed in the ECG set-upmenu of FIG. 35;

FIG. 37 is an exemplary respiration waveform as displayed by the vitalsigns monitoring device;

FIG. 38 depicts a portion of an exemplary display screen of themonitoring device and in particular an SpO₂ control menu;

FIG. 39 is a flow chart relating to a SpO₂ spot checking feature of thevital signs monitoring device of FIGS. 1-3;

FIG. 40 is an exemplary display screen of the vital signs monitoringdevice of the present invention, including a primary vital signs displayscreen with the SpO₂ icon highlighted after SpO₂ has been turned off;

FIG. 41 is a drop down pulse oximeter spot check menu accessed throughthe window navigation of FIG. 40;

FIG. 42 is an exemplary display screen detailing portions of the SpO₂spot-check feature in accordance with the present invention;

FIG. 43 is a later version of the display screen of FIG. 42 illustratingpulse oximetry data;

FIG. 44 is an exemplary display screen of the vital signs monitoringdevice illustrating a digital manometer feature;

FIG. 45 is the display screen of FIG. 44 at a later time during an NIBPreading, in progress;

FIG. 46 is the display screen of FIGS. 44 and 45 at a later timefollowing the NIBP measurement including depicting markers/indicatorsfor the user with respect to systolic, diastolic and mean pressurevalues;

FIG. 47 is an exemplary Power Off display screen of the vital signsmonitoring device;

FIG. 48 is an exemplary display screen of the vital signs monitoringdevice depicting in part, a wireless mode drop-down menu;

FIG. 49 is a display screen accessed and displayed by the vital signsmonitoring device when the device is disconnected from the wirelessnetwork;

FIGS. 50-52 depict examples of an exemplary display screen according toyet another display mode for the vital signs monitoring device of FIGS.1-3 illustrating snapshots of vitals signs data captured by the device;

FIG. 53 depicts a snapshot display screen similar to FIGS. 50-52, butfurther including a trends data selection menu;

FIGS. 54-56 depict various exemplary display screens of tabular trendedpatient data as displayed by the vital signs monitoring device of thepresent invention;

FIG. 57 depicts yet another example of a display screen according to yetanother display mode for the vital signs monitoring device of FIGS. 1-3,showing trended graphical data;

FIG. 58 depicts an exemplary alarm display screen of the vital signsmonitoring device of FIGS. 1-3;

FIG. 59 depicts an exemplary equipment alert display screen of the vitalsigns monitoring device of FIGS. 1-3;

FIGS. 60 and 61 illustrate exemplary display screens for the vital signsmonitoring device, including an alarms set-up menu in which audiblealarms can be enabled or disabled;

FIG. 62 illustrates examples of display screens in accordance with thepresent invention, including a parameter control menu wherein alarmlimits can be temporarily customized for an individual patient;

FIG. 63 is a signal output indicating how electrical noise can bediscriminated from pacer signals as detected by the device from aselected ECG vector; and

FIGS. 64 and 65 depict portions of an exemplary configuration worksheetused for configuring individual alarm limit settings to predeterminedpercentage amounts for the monitoring device in accordance with oneversion of the invention.

DETAILED DESCRIPTION

The following description relates to a specific embodiment for amulti-parametric, vital signs monitoring device that can be useduniversally for a number of different patient-related applications,including ambulatory, bedside, transport, procedure, and handheldoperations. It will be readily apparent, however, from the discussionthat follows to those of sufficient skill that numerous variations andmodifications are possible within the intended scope of the invention.In addition and throughout the text, a number of terms are used in orderto provide a suitable frame of reference with regard to the accompanyingdrawings, including “top”, “bottom”, “front”, “rear”, “back”, and thelike. These terms are not intended to be over limiting of the presentinvention, except in those instances where specifically indicated.

Referring to FIG. 1, the herein described patient monitoring device 20is defined by a housing 24 that receives input from a plurality ofsensors, each forming part of physiologic sensor assemblies 28, 32 and36, in this instance ECG, SpO₂ (pulse oximetry) and blood pressure(NIBP) assemblies. The housing 24 includes a display 88 for vital signnumerics, waveforms and other patient data, as well as a user interface92, FIG. 2, that permits operation of the monitoring device 20.

Referring to FIGS. 1-3, the display 88 is provided on a front facingside of the housing 24, as well as a plurality of adjacent actuablebuttons defining the user interface 92. According to the presentembodiment, the display 88 is a quarter (QVGA) color display, thedisplay according to this embodiment being approximately 3.5 inches(measured diagonally). More particularly and according to thisembodiment, the display 88 is an LCD having a pixel count of 240 by 320.The herein described display 88 preferably includes a backlight (notshown) to improve readability of the display under low ambient lightconditions.

As to the profile of the herein described device 20, the housing 24according to this specific embodiment is approximately 5.3 inches inheight, 7.5 inches in width, and 2.0 inches in depth. In spite of thelightweight design, however, the herein described monitoring device 20is extremely durable and rugged wherein the device is equipped to handlevarious loads that may be encountered in a patient-related setting. Forexample, the housing 24 includes a center or intermediate rubberizedbladder 26 disposed between a front housing half and a rear housing halfthat is disposed peripherally therebetween about the device housing 24in order to assist in cushioning the monitoring device 20 from impact orshock loads and to retain the interior of the device from dust or othercontaminants. To further assist in cushioning the monitoring device 20,each of the corners of the housing 24 are curved to provide an effectivecontour. A battery compartment (not shown) is also formed within thehousing 24, the cover of the battery compartment being essentially flushwith the rear facing side 61 of the housing such the compartment doesnot protrude from the overall profile of the monitoring device 20. Therear facing side 61 of the housing 24 further includes a set ofrubberized pads or feet 58, enabling the monitoring device 20 to beplaced on a flat surface, as needed. In addition, each of the buttonscomprising the user interface 92, discussed in greater detail below, areelastomerized to aid in the overall durability and ruggedness of themonitoring device 20, the buttons being positioned so as not to overlyprotrude from the facing surface 84 of the housing 24 and allowing thedevice to maintain a relatively compact profile.

The compact profile of the device housing 24 enables the monitoringdevice 20 to be patient wearable. A pair of tabs 132, FIG. 2, providedon opposing lateral sides of the device housing 24 enable the monitoringdevice 20 to be secured to a patient-wearable harness 135, such as shownin FIG. 9, or alternatively a strap 137 can be attached to the side tabs132, as shown in FIG. 8, permitting hand-held and portable operation ofthe monitoring device 20. The strap 137 can be used additionally fortransport operations along with a transport belt 139, such as shown inFIG. 10, with respect to a gurney 138 or other transport apparatus.Otherwise and as noted above, the herein described monitoring device 20can be suitably positioned upon a table or other flat surface using therubberized pads 58 provided on the rear facing side 61 of the devicehousing 24.

In addition to being compact and durable, the herein describedmonitoring device 20 is extremely lightweight. The entire assemblageshown in FIG. 1 weighs approximately two pounds.

As noted above and according to this embodiment, a plurality ofphysiologic sensor assemblies are tethered to the housing 24, includingan ECG sensor assembly 28, an SpO₂ sensor assembly 32 and a non-invasiveblood pressure (hereinafter NIBP) sensor assembly 36, respectively, thesensor assemblies being shown in FIG. 1 only for the sake of clarity.

A brief treatment of each tethered physiologic sensor assembly 28, 32,36 is now provided for the sake of completeness. More particularly andin brief, the SpO₂ sensor assembly 32 is used to noninvasively measureoxygen saturation of arteriolar hemoglobin of a peripheral measurementsite of a patient, such as the wrist, a finger, a toe, forehead, earlobeor other area. Reusable or disposable sensor probes can be used. In thisinstance, a finger clamp 60 is shown in FIG. 1, the clamp having a lightemitter and a light detector that can be used to detect pulse/heart rateas well as blood oxygen saturation through pulse oximetry. The fingerclamp 60 is tethered by means of a cable 64 extending to a pinnedconnector that mates with a corresponding female connecting port 44,FIG. 3, that is provided on the exterior of the device housing 24. Theconcepts relating to pulse oximetry in general are commonly known in thefield and do not form an inventive part of the present invention.

In brief, the ECG sensor or monitoring assembly 28 includes a lead wireassembly, wherein either a three-lead or a five-lead ECG can be utilizedaccording to the present embodiment. More particularly and by way ofexample, the herein pictured ECG sensor assembly 28 of FIG. 1 comprisesa set of lead wires 68, each having electrodes 70 at the ends thereof topermit attachment, in a conventionally known manner, to the body of apatient, the lead wire assembly comprising a harness 71 that is attachedto a connection cable 72 having a connector which is matingly attachableto the connection port 40 of the device housing 24. The ECG sensorassembly 28 is further utilized herein with respect to a respirationchannel of the herein-described monitoring device 20 in order todetermine the rate or absence (apnea) of respiration effort through thedetermination of ac impedance between selected terminals of ECGelectrodes 70, thereby determining the respiration rate of a patientusing impedance pneumography based upon movements of the chest wallusing a designated reference lead wire. Heart rate according to thepresent embodiment is detected for the herein described device 20 usingthe ECG sensor assembly 28.

The ECG sensor assembly 32 creates a waveform (ECG vector) for each leadand further includes a QRS detector that can be adjusted depending uponthe patient mode selected. The ECG sensor assembly 28 is furtherconfigured to determine heart/pulse rate, if selected, according to thepresent embodiment as well as mark pacer spikes in the resulting ECGwaveforms by way of a pacer detection circuit. The ECG sensor assembly28 according to the present embodiment further includes selectable notchfilters of 50 Hz and 100 Hz, 60 Hz and 120 Hz, respectively.

In brief, the NIBP sensor assembly 36 according to this embodimentindirectly measures arterial pressure using an inflatable cuff or sleeve76, which is attached to the limb (arm or leg) of a patient (not shown).The remaining end of a connected hose 80 includes an attachment end thatcan be screwed into a fitted air connector fitting 48 that is providedon the top facing side of the housing 24. The air connector fitting 48is connected to a pump (not shown) disposed within the monitoring devicehousing 24 in order to selectively inflate and deflate the cuff 76 to aspecified pressure, depending on the type of patient, using theoscillometric method. Pressure changes are detected by means ofcircuitry in order to determine systolic, diastolic and mean arterialpressure (MAP). The NIBP sensor assembly 36 according to this embodimentis capable of performing manual, automatic and a turbo mode ofoperation, as described in greater detail below. The assembly 36 canalso be equipped, in this embodiment, when ECG is also being monitored,with a motion artifact filter if ECG is also being monitored. The filteraccording to the present embodiment employs a software algorithm thatcan be used to automatically synchronize the process of NIBP measurementto the occurrences of the R-wave of the ECG waveform, thereby increasingaccuracy in cases of extreme artifact and diminished pulses. An exampleof a suitable NIBP artifact filter is described in U.S. Pat. No.6,405,076 B1, the entire contents of which are herein incorporated byreference. Examples of NIBP and ECG sensor assemblies useful forincorporation into the herein described monitoring device 20 aremanufactured by Welch Allyn Inc., of Skaneateles Falls, N.Y., amongothers. With regard to each, the form of sensor assembly can be varieddepending on the type of patient, (i.e., adult, pediatric, neonatal) byselective attachment to the connection ports 40, 48 that are provided onthe monitoring device 20. Each of the foregoing sensor assembliesaccording to the present embodiment further include electrosurgeryinterference suppression. As noted, pulse rate can be detected fromeither the SpO₂ or the NIBP channels of the monitoring device 20.

It is contemplated for purposes of the present invention, however, thatother means for connecting the above-noted sensor assemblies 28, 32 tothe monitoring device 20 other than through the connection ports 40, 44,including wireless means, such as for example, IR, optical, RF, andother nontethered connections could also be employed for purposes of thepresent invention. It should be further noted that the number of typesof physiologic sensor assemblies used with the herein described device20 can be varied and that those shown are intended to only be exemplaryof the present invention. The invention contemplates both multiple andsingle physiologic parameter monitoring of a patient using themonitoring device 20 and therefore such variation is purposely intended.

Referring to FIGS. 1 and 6, each of the above physiologic sensorassemblies 28, 32, 36 according to this embodiment are internallyconnected electrically to a CPU 174 that is contained within the housing24 of the monitoring device 20. According to this embodiment, signalprocessing for each of the physiologic sensor assemblies 28, 32, 36 isperformed internally through resident processing circuitry; for example,the SpO₂ sensor assembly 32 of the present embodiment utilizes theNellcor Puritan MP506 architecture while the NIBP sensor assembly 36 isbased upon a design, such as those used presently in the Micropaq andPropaq vital signs monitors, including, for example, an NIBP Module,Part 007-0090-01, manufactured and sold by Welch Allyn, Inc. Though notshown in FIG. 6, the resident circuitry for each of the sensorassemblies 28, 32, 36 are all integrated into a single logic boardwherein the ECG and respiration parameters utilize a common processor,such as a Motorola MPC 823 processor of the CPU 174. Despite beingintegrated into a single logic board, the remaining physiologicparameters (SpO₂ and NIBP) are implemented in a more modular fashion, asshown in FIG. 6, and utilize their own processors. It should be readilyapparent, however, that the electronic packaging of the variousprocessing elements of the physiologic sensor assemblies 28, 32, 36 ofthe monitoring device 20 can easily assume various configurations forpurposes of the present invention and other versions could easily becontemplated.

Still referring to the schematic diagram of FIG. 6, the containedbattery pack 170 is interconnected to the CPU 174, the latter includinga microprocessor, memory, and resident circuitry, wherein each areconnected to the tethered sensor assemblies 28, 32, 36 in order toenable processing storage and selective display of the signals providedtherefrom as well as perform power conversion between the chargingcircuit of an optional charging cradle 140 and the contained batterypack, including circuitry to prevent overcharging of the containedbattery pack 170 (i.e., 12 volts to 5 volts), as described in greaterdetail below. The CPU 174 according to this embodiment includesavailable volatile and nonvolatile storage for patient data, in the formof Flash memory and SRAM, though other form as are also possible, theCPU 174 being further connected to the display 88. As noted above, theCPU 174 according to this embodiment is presented on a single logicboard along with the processors for the physiologic sensor assemblies28, 32, 36. The CPU 174 is intended to handle device-specific aspects,such as alarm limits, display generation, and enabling and disabling ofcertain features, wherein the physiologic sensor assemblies 28, 32, 36predominantly only relate data for use by the CPU 174. It should benoted that portions of the processing function, for example, the ECGprocessing algorithms, can also reside in CPU 174, though this can bevaried appropriately depending, for example, on the extent of processingpower required or packaging concerns. The CPU 174, predominantlycontrols the operation of the device 20, including patient modes,pressures, voltages and the like, either as a factory default setting,or configured, as described below either through the user interface 92,a remote monitoring station 184, FIG. 6, and/or a connected PC 192, FIG.6.

In addition to the preceding, the monitoring device 20 as schematicallyrepresented in FIG. 6 further optionally includes a wireless radiocard/transceiver 180, enabling bi-directional wireless communicationwith at least one remote monitoring station 184, such as, for example,the Acuity Monitoring Station manufactured and sold by Welch Allyn Inc.,using the radio card as inserted in an internal PCMCIA expansion slot(not shown). The radio card 180 according to this embodiment is an IEEE802.11 compliant radio card that connects to an antenna 182 that is alsodisposed within the housing 24 of the monitoring device 20 fortransmission over a 2.4 GHz frequency hopping spread spectrum (FHSS)wireless local area network (WLAN) using access points 186. Additionaldetails relating to an exemplary wireless interconnection, includingnetworking therewith, is provided in U.S. Pat. No. 6,544,174, the entirecontents of which are herein incorporated by reference. Additionaldiscussion of device-specific details relating to the wirelessconnection of the herein described monitoring device 20 is provided in alater portion of this description.

As most clearly shown in FIG. 2, a lower or bottom facing surface 120 ofthe device housing 24 includes a latching member 124, FIG. 2, as well asan electrical port 128, FIG. 2, each of which are used in conjunctionwith an optional charging cradle 140, FIG. 4, described in greaterdetail below. As previously noted, the battery pack 170, only shownschematically in FIG. 6, is contained in the rear of the device housing24 within a rear compartment (not shown). The battery pack 170 providesportable power for the monitoring device 20 wherein the battery life isdependent upon certain operational modes of the device, as describedbelow. The battery pack 170 is rechargeable by means of chargingcircuitry contained within the optional charging cradle 140, FIGS. 4, 5.According to this embodiment, the battery pack 170 includes at least onerechargeable lithium-ion battery, such as those manufactured by SanyoCorporation. In this instance, the battery pack 170 includes tworechargeable batteries. According to the present embodiment, themonitoring device 20 is capable of operation in a stand-alone mode usingthe contained battery 170 as a power source, the battery according tothis embodiment having an average runtime of up to approximately 24hours, depending on the usage of the device.

Referring to FIGS. 4-6, details relating to the charging cradle 140 andits optional connection with the monitoring device 20 are hereindescribed. The charging cradle 140 permits DC power from a wall adapter171, shown only schematically in FIG. 6, or other source to be suppliedto the contained rechargeable battery pack 170 through chargingcircuitry contained in the cradle and power conversion circuitrycontained in the monitoring device. The use of the optional chargingcradle 140 permits the monitoring device 20 to be operated regardless ofthe status of the contained battery (i.e., charged or uncharged),therefore enabling use of the monitoring device 20 as a stand-alone ornetworked bedside monitor. That is, the foregoing operation can permitboth the internal display of patient data as well as wirelesstransmission of stored patient data to the central monitoring station184.

Structurally, the charging cradle 140, according to the presentembodiment, is defined by an open-topped receptacle 144 having a moldedor otherwise defined internal cavity that is sized to receive the lowerhalf of the monitoring device 20. The receptacle 144 is designed toallow operation of the monitoring device 20 via the user interface 92,as shown in the attached view of FIG. 5, when the device is attachedthereto. A monitor release button 148 is provided on a front facing side152 of the receptacle 144. The monitoring device 20 is engaged byaligning the bottom facing surface 120, FIG. 2, of the device housing 24with the internal cavity of the receptacle 144 and more specificallyaligning the latching member 124 provided thereupon with a pivotallymovable locking or latching element 156 that is disposed within thebottom of the internal cavity of the receptacle 144. A pinned electricalconnector 160 adjacent the latching element 156 mates with thecorresponding electrical connector 128, FIG. 2, provided on the bottomfacing side 120, FIG. 2, of the device housing 24, FIG. 2, and therebyprovides electrical connection between the monitoring device 20 and thecharging cradle 140, as schematically shown in FIG. 6. Engagement of thelatching member 124 with the latching element 156 locks the monitoringdevice 20 in place wherein depression of the monitor release button 148causes the latching element 156 to be pivoted out of contact with thelatching member 124, allowing release of the monitoring device 20 fromthe charging cradle 140.

A rear engagement portion 164 of the charging cradle 140 includes acurved hanging bracket 166, permitting the charging cradle and attachedmonitoring device 20 to be attached to a bedrail, as shown, for example,in FIG. 11. Alternatively, the hanging bracket 166 can further includeat least one other mount (not shown) that permits attachment to separateapparatus, such as a fluid-IV pole (not shown). In one version, thehanging bracket 166 can include both attachment modes (bedrail, IVpole). The hanging bracket 166 is separably removable by way of threadedfasteners (not shown) or other means from the rear engagement portion164 to permit other attachment arrangements, such as those discussedbelow with reference to FIGS. 11-13. The bottom surface of the chargingcradle 140 according to this embodiment further includes a plurality ofsupport feet 149, FIG. 5. According to this embodiment, the support feet149 are provided at each corner of the bottom surface in order to permitplacement onto a flat surface, such as a table 203, FIG. 12.

A pair of indicators 167, 168 are provided on the front facing side 152of the charging cradle 140 wherein according to this embodimentindicator 167 is a status indicator and indicator 168 is a powerindicator. The power indicator 168, in this instance, a green LED,indicates that power is connected to the charging cradle 140. The statusindicator 167, in this instance, a multi-colored LED, is used toindicate the charging status of the monitoring device 20. For exampleand if the monitoring device 20 is in the charging cradle 140 and poweris properly connected to the charging cradle from the wall adapter 171,FIG. 6, the status indicator 167 will be illuminated (e.g., either greenor yellow) or will be off. When the status indicator 167 is green,charging is proceeding normally. The status indicator 167 is turned offwhen the battery pack 170 reaches full charge. When the status indicator167 is yellow, the indicator indicates that a fault has occurred and thebattery pack 170 is not charging properly. Such faults may occur, forexample, as those caused by a severe discharge of the battery 170, acradle logic fault, incorrect seating of the monitoring device 20 withinthe charging cradle 140, improper engagement of the connectors or othersimilar anomaly.

In spite of most charging faults, as noted above, power will not beinterrupted to the monitoring device 20. That is, the power indicator168 may be illuminated (e.g., green), indicating power is capable ofbeing delivered to the monitoring device 20 in spite of the fact that acharging fault (yellow) has occurred. Each time the monitoring device 20is placed into the charging cradle 140 according to this embodiment, thecradle attempts to charge the contained battery pack 170. If the batterypack 170 is fully charged when the monitoring device 20 is inserted intothe charging cradle 140, the status indicator 167 turns greenmomentarily and upon sensing of a full charge, the indicator is turnedoff. In the instance that the battery is overcharged at the device 20,however, no power for charging the battery pack 170 will be delivered tothe device.

Typically, the herein described monitoring device 20 is shipped to auser/facility with a preset factory configuration for each setting andbehavior of the device. It is desirable for most facilities toreconfigure any received patient monitoring device 20 to conform thedevice to local protocol and adapt the device to the clinicalenvironment to which the device will be used. For example, themonitoring device 20 might be used in a neonatal unit although thefactory calibration/configuration is preset for adult patients. Althoughthe user could custom configure the monitoring device 20 upon each useto allow the device to be used for neonatal patients, as described ingreater detail herein, it may be preferable to have neonatal modeinstalled as the default patient mode for a monitoring device.

According to the present invention, a PC 192, FIG. 6, can be used inconjunction with the charging cradle 140 to download a new configurationfile to the monitoring device(s) 20 prior to use in a facility forservice. According to the present embodiment, the charging cradleincludes a USB data port 165, FIG. 4, provided on the exterior of thecharging cradle 140 that provides an isolated serial data-linkconnection between the attached monitoring device 20 and the personalcomputer (PC) 192, FIG. 6, through a USB cable.

Using a configuration utility supplied through the data link with the PC192, the charging cradle 140 serves as an intermediary or pass throughto the monitoring device 20 to configure the monitoring device prior touse in a facility by creating a configuration file that includes aplurality of setting choices that can be completed, for example, by thebioengineer of the hospital, to adapt onto or to replace pre-existingfactory settings initially provided with the device 20 that are storedor programmed within the CPU 174. According to this embodiment, the PC192 includes utility software that enables the creation of a utilityconfiguration worksheet into which default settings and limits can beentered. The worksheet is then converted into the new configuration filethat is downloaded into the CPU 174 of the monitoring device 20 throughthe intermediary charging cradle 140. As many as approximately 60-70different settings, depending on the device, can be preset using thedownloaded configuration file wherein some of these features, if notenabled, cannot be controlled by the clinician/user. These settings caninclude, for example, the default language of the monitoring device 20,the default patient mode of device operation, forms of display availableto the user and/or their ordering, the enablement of device specificfeatures, such as, for example, lockout of the user interface 92 anddisplay 88, time limits on alarms and alerts, data trending, and theenablement of alarm and alert tones. All or certain of the factorysettings can be adjusted by appropriate entries provided on theconfiguration worksheet created at the PC 192 and communicated throughthe data link between the CPU 174 and the PC 192. Therefore, this PCconfiguration results in a set of revised default settings andmonitoring device behaviors.

A portion of an exemplary configuration worksheet is shown in FIGS. 64and 65 with regard to one specific feature that can be enabled withregard to alarm management. Specifics relating to this feature aredescribed in greater detail in a later section. The worksheet 198 shownis a paper version that is completed by a user in advance to using theconfiguration utility, the latter providing a PC worksheet version thatprovides similar entries. The user completes the paper configurationworksheet 198, FIG. 64, to organize the features for configuration orcan directly input selections into the utility worksheet provided at thePC 192, FIG. 6. Once all entries have been made, the configuration fileis created with instructions to override the factory settings when thefile is downloaded to the monitoring device 20 through the serial datalink provided by the charging cradle 140.

As will be described in greater detail below, the PC 192, FIG. 6, alsopermits stored data to be printed automatically when the monitoringdevice 20 is activated and attached to the charging cradle 140, alsousing the associated USB data port 165, FIG. 4. In this instance andreferring to FIG. 6, the PC 192 is connected to a suitable peripheralprinter, in this instance, a laser printer 195, also schematically shownin FIG. 6, wherein the monitoring device 20 and PC are programmed toautomatically permit data transfer to occur. According to thisembodiment, the data that is stored is in the form of trended data and“snapshots”, the latter term referring to numeric and waveform datacovering a predetermined time period that is selectively taken by a userusing the snapshot button 116. Pressing the snapshots button 116, FIG.7, located on the device housing 24, FIG. 2, causes data occurring apredetermined time period prior to pressing the button and apredetermined time period after pressing the button to be stored by theCPU 174. Details relating to stored trend and snapshot data are providedin a later portion of this description.

Referring to FIGS. 6 and 11-14, the charging cradle 140 canalternatively serve to provide an intermediary interconnection betweenthe herein described monitoring device 20 and a large display 200. Thisform of interconnection permits all processed data in the monitoringdevice 20 to be transmitted in real time in order to permit viewing ofthe data substantially as though users were at the central monitoringstation 184, as opposed to the smaller and constricted device display88. That is, a series of waveforms can be displayed for viewing, forexample, as shown in FIG. 14. The large display 200 according to thisembodiment includes a VGA card and suitable attachment bracketry in theform of an interface box or housing 202. Several embodiments forinterconnection of the monitoring device/charging cradle assembly to thelarge display 200 through the interface box 202 are illustrated in FIGS.11-13. In each embodiment, the monitoring device 20 is already attachedto the charging cradle 140 in the manner described above. According toFIG. 11, the charging cradle 140 is attached to a bedrail using thehanging bracket 166. A VGA cable 205 is then connected from the USB dataport 165, FIG. 4, to connectors that are provided on the interface box202. As such, the charging cradle 140 serves as an intermediary for datatransfer from the patient monitoring device 20. As shown in FIG. 12, thecurved bracket 166, FIG. 4, can be removed from the rear engagementportion 166, FIG. 4, of the charging cradle 140 and the monitoringdevice 20/charging cradle 140 can be placed on a table 203 adjacent thelarge display 200, the latter being attached in each instance to a wall.In the latter example, the interface box 202 is directly attached to therear of the charging cradle 140. Finally and as shown in FIG. 13, themonitoring device 20 and charging cradle 140 can be attached to theinterface box 202 directly on the large display 200 through the displaybracketry and bracketry that is provided on the charging cradle 140,respectively. A sample data output of the large display 200 is shown inFIG. 14, this output substantially replicating that seen by the remotemonitoring station 184, FIG. 6, and considerably an increased amount ofdata than is viewable on the integrated display 88.

It is further contemplated within the spirit and scope of the presentinvention that the charging cradle 140 can include additional featuresto provide a level of adaptability for a system incorporating the hereindescribed monitoring device 20. For example, an additional physiologicparameter assembly could be attached to the charging cradle 140 in lieuof or in addition to the monitoring device 20 wherein physiologic datacould still be uploaded to the monitoring device 20 when the device isattached to the charging cradle for wireless transmission to the centralmonitoring station 184, FIG. 6. Similar configurations should be readilyapparent. For example, the charging cradle 140 can be equipped with atleast one physiologic sensor assembly (not shown) wherein data collectedby the at least one sensor assembly can be inputted to the CPU 174 ofthe monitoring device 20 for display and transmission.

With regard to running time available on the monitoring device 20 whenthe device is not mounted in the charging cradle 140, the life of thebattery pack 170 is highly dependent on the use mode of the device. Asnoted above and according to this embodiment, about 24 hours of runtimeis possible. The level of battery charge is displayed by the monitoringdevice 20 according to this embodiment, as described below.

Referring to FIG. 7, the user interface 92, FIG. 2, according to thisspecific embodiment includes five (5) closely arranged buttons forming akeypad. In brief, a center button, referred to throughout as a SELECTbutton 96, is generally used to select a highlighted item that isdisplayed by the device, as discussed in greater detail below, or toconfirm a choice. Four buttons 100 immediately surrounding the SELECTbutton 96 are generally used (up, down, left or right) in order todirectionally guide a display cursor in order to highlight an item, forexample, or to increase or decrease a selected parameter value. A numberof additional actuable buttons are also provided, according to thisembodiment, on the front facing side 84 of the housing 24, these buttonsbeing used for specified or dedicated purposes, including a displaybutton 104, permitting the user to cycle between a plurality of varieddisplay formats, such as those shown in FIGS. 15-19, an alarmsilence/resume button 108 permitting the user to temporarily andmanually silence or resume an existing patient alert/alarm tone, an NIBPstart/stop button 112 for manually starting or stopping an NIBPmeasurement, and finally the above referred to snapshots button 116 thatautomatically stores a predetermined time period of vitals-signs data inboth tabular and waveform format, an exemplary snapshot display screenbeing shown in FIG. 50. Each of the above-described buttons furtherinclude a visual representation of their function for ease of use by theclinician; for example, the directional control buttons 100 includespecific directional arrow indicators, the display button 104 includes adisplay icon, the NIBP start/stop button 112 includes a depiction of ablood pressure cuff, the snapshots button 116 includes a camera icon andthe SELECT button 96 depicts a circle thereupon. Additional detailsconcerning the functions defined by each of the above-listed buttons,and the implementation and operation of the user interface 92 of theherein described monitoring device 20 will be described in greaterdetail in a succeeding section of this description.

Referring to FIGS. 2, 5 and 7 and in addition to the above userinterface 92, a series of visual status indicators are also provided onthe front facing side 84 of the monitoring device 20. Three statusindicators 169 are arranged in linear fashion above the display 88 atthe center of the front facing side 84 of the device housing 24, and areelectrically connected to the CPU 174, FIG. 6. Among the purposes of thevisual status indicators 169 according to this embodiment are to apprisethe user of the operational status of the monitoring device 20; that is,whether the monitoring device 20 is operating normally, confirmation ofthe connection of the monitoring device 20 and the proper patient beingconnected to a network or to a remote monitoring station 184, FIG. 6,and/or whether the herein monitoring device 20 is subject to an alarmand/or alert condition. It should be readily apparent that the numberand location of these indicators can be suitably varied.

More specifically and according to the present embodiment, each of thestatus indicators 169 are illuminated with a specific colored light(e.g., red, yellow or amber, and green), indicating an alarm condition,an alert condition, and normal operation of the monitoring device 20,respectively. For purposes of definition herein, an “alarm” isindicative of a patient condition, such as vital signs reading(s) thatis outside of acceptable limits. When an alarm condition occurs, forexample, the red indicator 169 is illuminated. An “alert” condition, bycomparison, is not as serious as an “alarm” condition and is typicallyindicative of a device-operational problem, such as a low or dischargedbattery or a detached lead. The yellow status indicator 169 isilluminated when this type of condition is indicated. Normal operationis signified by illumination of the green indicator 169. The statusindicators 169 can further either illuminate steadily or flash in orderto indicate the severity of the problem. For example and according tothis embodiment, this severity can be defined between an equipment alertand an alarm condition. The monitoring device 20 further includes aspeaker 161, shown only schematically in FIG. 6, for signifying audibletones, as needed, for example, that may be sounded during an alarm oralert condition. Additional details relating to alarm and alertmanagement using the herein described monitoring device 20 are describedin a later portion.

Each of the tethered sensor assemblies 28, 32, 36 provide physiologicparameter data in the form of analog signals and the like to the CPU 174of the monitoring device 20. The herein described monitoring device 20is capable of continuously monitoring each of the physiologic parameters(NIBP, pulse rate, 3 and 5 lead ECG, respiration, SpO₂) depending on thenumber and type of sensor assemblies that are connected therewith.

As depicted in the operational block diagram of FIG. 6 and as previouslynoted herein, each of the SpO₂ sensor assembly 32 and the blood pressure(NIBP) sensor assembly 36 according to this embodiment include their ownindividual processors contained within the monitoring device 20 thatoperate the sensor assemblies with regard to the acquisition of andprocessing of data (that is, each of the above sensor assemblies includeappropriate algorithms and resident circuitry for processing theacquired signals). The ECG/respiration sensor assembly 28 according tothis embodiment includes attendant circuitry within the CPU 174. Aspreviously noted, any or all of the sensor assemblies can includemodular processors or the processing can be carried out within a singleintegrated logic/CPU board. The signals then being processed are storedinto the memory of the CPU 174 for display and for wireless transmissionusing the contained transceiver 180 and antenna 182 to the centralmonitoring station 184 using the communications network, as described inthe previously incorporated U.S. Pat. No. 6,544,174. Additional data,such as patient demographics, can be added for storage and display bythe user, as discussed below, or may alternately be uploaded to themonitoring device 20 from a list of available patients from the remotestation 184. The monitoring device 20 can transmit patient information,once configured with the network, for display of all stored parametricdata at the remote monitoring station 184. The monitoring device 20 isalso connectable through the USB port 165, FIG. 4, of the chargingcradle 140, enabling operation as a bedside monitor in which serialattachment to the PC 192 through the USB port 165 enablesinterconnectivity to a peripheral device, such as a printer 195, aspreviously described or alternatively, to the larger display 200. In themeantime, the monitoring device 20 can also transmit wirelessly to theremote monitoring station 184 using the connected radio 180 and antenna182.

The versatility of the herein described monitoring device 20 thereforeprovides a number of distinct advantages. First, the herein describedmonitoring device 20 can be used as a transport monitor in that thedevice is battery powered. Second, the use of the rubberized back feetor pads 58, the rear interior loading of the battery pack 170 andgeneral packaging and compactness of the profile of the monitoringdevice 20 present a lightweight and extremely versatile unit that allowsfor both wired and wireless connectivities enabling the device to workin either a stand-alone or a networked capacity. The charging cradle140, FIG. 4, permits the monitoring device 20 to be used for bedsideapplications by providing a source of power for the contained batterypack 170 as needed and for charging same. In addition and through use ofthe data port, the charging cradle 140 serves as an intermediary devicethat enables data transfer to either a large display 200 or printing toa locally connected computer 192. The locally connected computer 192 canalso be used to selectively modify factory programmed configurationsettings of a monitoring device 20 through new default settings that canbe downloaded to the monitoring device 20.

The following discussion relates to the operational aspects of themonitoring device 20. Reference is made throughout to numerous exemplarydisplay screens that are generated by the CPU 174 of the hereindescribed monitoring device 20. Each display screen is defined by astored preformatted template consisting of a number of discrete panelswith each panel including a number of elements that are defined byvarious combinations of textual, numeric, waveform, graphical and/orother forms of data, as described herein that are obtained from the CPU174 and generated onto display 88.

Upon powering up the herein described monitoring device 20 using thePower On/Off button 56, an audible tone from the contained speaker 61,FIG. 6, is sounded. With each activation of the monitoring device 20according to this embodiment, a self-diagnostic or operational test isinitiated. If the self test is unsuccessful, at least one of the statusindicators 169 of the monitoring device 20 is illuminated, depending onthe error. In terms of a general overview and if the self test issuccessful and following this diagnostic, a start-up display screen400(a), 400(b), FIG. 24, appears on the display 88, FIG. 1, with thedisplay screen having user-selectable options to continue monitoring apatient (in the event patient data has been saved), start monitoring anew patient, obtain system information, or enter a demonstration mode.

Referring to FIG. 24, the stored template format of each of thegenerated start-up screens 400(a), 400(b) is similar whether or notpatient data has previously been stored by the monitoring device 20.That is, each start-up display screen 400(a), 400(b) commonly includes acustomer ID panel 404, a notice panel 408, a bottom message panel 412and a context menu panel 416, respectively, as read from the top of thedisplay screen. In the instance that no patient data has previously beensaved by the monitoring device 20, the notice panel 408 of start-updisplay screen 400(a) indicates by way of a textual message that no datahas been saved. The notice panel 408 of the other version of the displayscreen 400(b), on the other hand, indicates that specific patient datahas been previously stored by the monitoring device 20. In the instancethat a patient's data was stored prior to the time the monitoring device20 was last turned off, monitoring can be resumed for that patient whenthe monitoring device 20 is powered up again. When the patient data issaved by the monitoring device 20, the settings of the monitoring device20 are also saved into the nonvolatile memory of the CPU 174. In thisinstance, a decision must be made by the user as to whether the data isto be saved and monitoring will continue with the same patient orwhether the stored patient data should be deleted and a new patientmonitoring mode should be initiated.

The customer ID panel 404 provides information about the facility anddevice that have been previously entered and stored in an informationscreen, such as shown in FIG. 26, shown as 420(a), 420(b). Theinformation screen 420(a), 420(b) can be accessed from the Info optionof the context menu panel 416. Each of the information screens 420(a),420(b) also include a context menu panel 416 at the bottom thereof,including the same options as the start-up screens 400(a), 400(b),respectively. Typically, this information can be added to the memory ofthe device 20, such as during the creation and downloading of theconfiguration file using PC 192, FIG. 6, as described previously.

In general, the context menu panels 416 provide a means for navigationbetween various control screens of the herein-described monitoringdevice 20. Each context menu contains a number of menu options disposedalong the length of the panel 416. The user interface 92 and inparticular, the directional buttons 100 and the SELECT button 96 areused to highlight and select a highlighted option by movement of thedisplay cursor. To that end, selection of one of the context menuoptions executes a new mode of the monitoring device 20 or creates a newdisplay screen, as described in greater detail below. The content andoptions available in context menus vary depending on the display screenwhich utilizes them. Examples of various context menus 416 that are usedin the operation of the monitoring device 20 are provided in FIGS. 25,28 and 47, each of which are detailed in a later portion of thisdescription.

Referring back to FIG. 24, and to the specifics of the context menupanel 416 of the start-up display screens—in the instance in which noprevious patient data has been stored by the monitoring device 20, thecontext menu panel 416 indicates the following available user-selectableoptions; namely, a Start New Patient option, an Info option, and a Demooption. The Start New Patient option permits the user to enter a patientmonitoring mode. The Info option reverts the user to an informationscreen, such as either 420(a), 420(b) shown in FIG. 26, while selectionof the Demo menu option provides access to a demonstration mode for themonitoring device 20.

In the instance that patient data has been saved by the monitoringdevice 20, the above three (3) user-selectable options are provided inthe context menu panel 416 of display screen 400(b), as well as aContinue Patient option. To resume monitoring on the same patient andupon powering up the monitoring device 20, the “patient data stored”display screen, 400(b), FIG. 24, is displayed. The user then verifiesthat the displayed name and patient ID match that of the current patientand upon verification, and highlights the Continue Patient option in thecontext menu panel 416 at the bottom of the display screen 400(b). Ifthe latter option is selected through use of the directional arrowbuttons 100 and pressing the SELECT button 96, then any stored data isloaded and the monitoring device 20 is ready for monitoring, includingthe continued implementation of any previous custom configurationsettings that are particular to the patient.

If, however, the Start New Patient option (onto which the display cursoris highlighted in the display screen 400(b)) is elected and the SELECTbutton 96 is pressed, then all previous data (and custom configurationsettings) are deleted and a new patient monitoring mode is initiated.

Upon election of the Start New Patient option, a first configured datadisplay screen 430 appears, as shown in FIG. 27. In this data displayscreen 430, a unique auto ID is provided in a status panel 320, and morespecifically in a device ID field 434 that is highlighted using theSELECT button 96, accessing a Patient Information Entry screen 440, asshown in FIG. 28, the latter consisting of a table of alphanumericcharacters 444 that can be highlighted and sequentially entered into theproper field 448 to create entries. The name of the new patient is thenentered as well as the patient ID and the patient room number.Alternatively, this data can be entered using the remote monitoringstation 184, FIG. 6, through an enabled wireless connection as opposedto the above-described local entry of information. When all of the aboveinformation is entered, a Confirm option provided in the context menupanel 416 of the display screen 440 is highlighted and the SELECT button96 is pressed. All information entered is then stored into memory of theCPU 174 and is used by the device in various display screens throughoutthe operation of the monitoring device 20. The mode of the patient isthen confirmed and the sensor assemblies 28, 32, 36 are attached to thepatient and the monitoring device 20 (if not already attached to thedevice). The monitoring device 20 is now ready to begin monitoringwherein readings are displayed on a formatted default data displayscreen, such as shown in FIG. 27, in predetermined fields on a displayscreen adjacent to text identifiers that are preformatted on thegenerated screen template. The screen format shown in FIG. 27 is that ofa large numerics display screen, discussed in greater detail below.

For purposes of the following discussion, it is assumed that each of thesensor assemblies 28, 32, 36 have been suitably attached to a patient(not shown) and the monitoring device 20 and that the patient has beenmonitored for an extended period of time by the device. A number ofspecifically configured display screen template formats are stored inmemory of the CPU 174 and are available for viewing at the user'soption, these templates including associated vital signs data in theform of either current or trended data. An exemplary default displayscreen 210, FIG. 15, for purposes of this discussion is enabled by wayof the configuration settings of the monitoring device 20, this screenbeing the current display screen displayed to the user duringmonitoring. The format of this particular display screen 210 includes astatus panel 320, a large waveform panel 324 and a parameter panel 328,respectively, as read from the top of the display screen.

The displayed data that is shown in FIG. 15 as contained in the variousfields of the status panel 320 includes the following elements: thepatient's name, if available, shown as 204, the patient ID 208, and thepatient room number 209. Each of the preceding elements were manuallyadded to the internal memory of the monitoring device 20 and added atstart-up as previously described above with regard to FIGS. 27 and 28 bythe clinician or alternatively in the case of a network-enabledmonitoring device 20, by the remote monitoring station 184, FIG. 6,prior to monitoring of the patient over a wireless communications link.In the former instance, this information as entered in the Patient EntryInformation display screen 440, FIG. 28, by the CPU 174 is used topopulate the status panel 320 of each display screen of the hereindescribed monitoring device 20 for the patient currently beingmonitored, for so long as power is maintained to the device, unless theuser elects to specifically maintain these settings prior to turning thedevice off, as described in greater detail below.

Referring to FIG. 15 and in addition to the patient information, thestatus panel 320 further includes a communication status icon 212 (ifthe device includes a wireless transceiver 180, FIG. 6, and antenna 182,FIG. 6) and a time display 216, as well as a battery status indicator oricon 220, the latter providing an indication of available battery power.The battery status icon 220 can provide an indication as to whether thecontained battery pack 170 is full, partially full indicating that thebattery is not fully charged, but not fully discharged, partially fulland charging, low battery wherein the battery has approximately 30minutes of runtime remaining, low battery and charging, very low batterywherein the battery has approximately 5 minutes of run time remainingand very low battery but charging. In the instances in which low batteryis indicated by the icon 220 (as indicated by a depiction of ahalf-filled battery) and in addition to the icon, an alert (not shown)can be provided by the monitoring device 20. The battery status icon 220would remain after acknowledgement of the alert. Alerts and theirmanagement are discussed in a later portion of this description.

According to this embodiment, the CPU 174 is programmed to automaticallydisable the NIBP sensor assembly 36 upon a low battery indication beingdetermined wherein a status message is displayed to the user if themanual NIBP start/stop button 112 is pressed. If the monitoring device20 is charging in the charging cradle 140 and a low battery and chargingindication appears via icon 220, then the NIBP sensor assembly 36 isenabled.

In addition to the above, the mode (adult, neonatal, pediatric) of thepatient 224, as well as the mode of the device 228 (simulation,monitoring) are each applied within separate fields that are provided inthe status panel 320 of the display screen 210. Each of the foregoingare typically based upon default settings of the herein describedmonitoring device 20, unless modified by the user, as described ingreater detail below.

With regard to the waveform panel 324, the depicted waveform 240 iscurrent and can originate from a number of sources. The panel 324further provides text identifiers relating to the specific waveformsource 232 and waveform size (display scale) 236. In this example, awaveform representative of an ECG vector is represented. The waveformdepicted, including its size and source as displayed, are also typicallybased upon a default setting of the monitoring device 20, wherein eachsetting may be changed locally by the user or remotely by the remotemonitoring station 184, as described below.

Beneath the waveform panel 324 and in the formatted parameter numericspanel 328, current or live parameter numeric values are displayed forheart rate/pulse rate 244, respiration rate 252, and pulse oximetry 256,as well as a separate dynamic indicator for the pulse amplitude of thepulse oximeter sensor in the form of a blip bar 260. Text identifiersare also provided beneath each above-noted parameter. In addition, themost recent NIBP measurement 248 is also displayed, with a correspondingtext identifier and time stamp, the pressure measurement being displayedin terms of systolic over diastolic numerics with mean pressure beingexpressed in parenthetical terms. Since each of these physiologicparameters, except NIBP, are continuously monitored, their numericvalues will change and be updated with stored data being trended by theCPU 174, FIG. 6. Finally, a series of alarm status indicators 268 arealso represented in the parameter numerics panel 328 at the bottom ofthe display screen 210 for each listed parameter. These alarm indicators268, represented herein by bell icons indicate whether the upper andlower limits for each physiologic parameter are on, the upper alarmlimit is on but the lower alarm limit is off, the upper limit is off butthe lower limit is on, or all alarms are off through an appropriaterepresentation of an alarm symbol, whether in blank or solid, andcombinations thereof. Alarms are described in greater detail in a laterportion of this description.

Each of FIGS. 16-19 depict additional exemplary display screens that canbe selectively displayed by the user in addition to the single waveformdisplay screen 210 depicted in FIG. 15. Each of these additional displayscreens include a specifically defined template format that is storedinto memory for generation by the CPU 174 onto the display 88. Accordingto this specific embodiment, these additional user-selectable displayscreens include a dual waveform display screen 332, shown in FIG. 16, alarge numeric display screen 336, shown in FIG. 17, which is similar tothat shown also in FIG. 27, and a single waveform with tabular trendeddata display screen 340, as shown in FIG. 18. For purposes of discussionherein, each of the same reference numerals are used to label similardata and symbology herein for the sake of convenience and clarity. Theabove-noted display screens permit live monitoring of vital signnumerics, waveforms and/or trend information in various user-selectableformats as now described.

The dual waveforms display 332 screen of FIG. 16 is a variation upon thesingle waveform display screen 210 of FIG. 15. This display screen 332provides patient and monitoring device information as well as twowaveforms and available parameter numerics. To that end, the definedformat of this display screen 332 includes a status panel 320 thatincludes each of the elements of the single waveform display screen 210referred to above including patient name 204, patient ID 208, patientroom number 209, communication status indicator 212, time display 216,battery status indicator 220, patient mode indicator 224, and displaymode indicator 228. Two small waveform panels 344 are provided in lieuof the single panel of the display screen 210, FIG. 15, the displayscreen further including a live or current parameters numerics panel328, similar to that of the single waveform display screen 210, FIG. 15.Each of the waveform panels 344 are smaller than that of the singlewaveform data display screen 210, but contain similar informationincluding waveform source 232 and size indicia 236. The waveformspresented in the panels 344 can be from two different sources or can beprovided alternatively as a cascaded waveform from one source that ispresented on two adjacent waveform panels. In the example shown in FIG.16, separate ECG and SpO₂ waveform 240, 242, respectively, are depicted.The live parameter numerics panel 328 like the preceding includes aheart rate/pulse rate numeric and text identifier 244, the most recentlytaken NIBP numeric 248 including the systolic/diastolic and mean(parentheses) numerics and text identifiers as well as a correspondingtime stamp, a respiration numeric and text identifier 252, and an SpO₂numeric and text identifier 256 including a dynamic blip bar 260 showingpulse amplitude. Alarm icons 268, in the forms of bell icons, are alsoprovided for each of the preceding parameters in this panel 328.

The large numerics display screen 336 shown in FIG. 17 is similar tothat depicted in FIG. 27, labeled as 430 (but without data or patientinformation entered). This display screen 336 is defined by a formatthat includes a status panel 320, also similar to that described for thedisplay screens of FIGS. 15 and 16, and a large numerics panel 352provided in lieu of waveform panels. The large numerics panel 352contains the same information provided in the panel 348 discussed withregard to FIG. 16 other than that the icons and associated textidentifiers are significantly larger and disposed in differentlyassigned fields in the display screen 336. More specifically, the liveor current parameters panel for this display screen includes a largeHR/PR numeric element 244 as well as a text element and an alarm icon268, a large SpO₂ numeric element 256 along with an associated textelement, alarm icon 268 and blip bar 260, a large NIBP numeric element248 representative of the most recent measurement as well as a textelement and time stamp of measurement and alarm icon 268 and a largerespiration numeric element 252 along with an associated text elementand alarm icon 268. With regard to the alarm icons 268, these provide anindication of those alarms that are currently enabled and those alarmsthat are currently disabled. For purposes of this discussion, the lefthalf of each alarm icon 268 relates to the lower alarm limit and theright hand side of the icon refers to the upper alarm limit. A solidbell, shown herein as white, indicates that the alarm is enabled while ablackened portion of the bell indicates that the alarm is disabled.Alarms are provided (upper and lower limits) for each of heartrate/pulse rate, respiration, NIBP (systolic, diastolic and mean) andSpO₂. As seen in the depicted example, the lower limit of the mean NIBPis currently disabled while the remaining alarm limits are eachcurrently enabled. The alarm icons 268 further permit the user to accessmenus, as described in greater detail below, by which the alarms can beenabled or disabled, upper and lower limits can be set, and volumecontrols for audible tones can be adjusted.

The herein described monitoring device 20 can not only display currentor recent numerics and waveforms, but is also storing data for trendanalysis. To that end, several display formats relate to trended data,wherein this data can be reproduced either graphically or tabularly.Snapshot data is also stored in addition to any periodic or randomlytaken measurement data and data stored by the device 20 based uponcontinuous monitoring. To that end, FIG. 18 illustrates a combinationwaveform/tabular trend display screen 340. In this example, a waveformas well as live parameter numerics and tabular list of trend data aredepicted in a generated template format on the display 88 pertaining toa monitored patient. The pre-defined format of this display screen 340includes a status panel 320, similar to that described with regard toFIG. 15, a single waveform panel 344 including a waveform and textidentifiers relating to the waveform source 232 and size 236,respectively, similar to those described in FIG. 16, a trends livenumeric panel 356 and a trends data panel 360, respectively.

The trends live numerics panel 356 includes a data display header 364relating the form of data presented (tabular, graphical, or other)followed by a linear set of current heart rate, respiration and SpO₂parameter numerics and the most recent NIBP measurement, as well as textidentifiers beneath each corresponding parameter numeric and the currentblip bar 260 for SpO₂. A “Time” table heading is also provided beneaththe data display header 364.

The trends data panel 360 of this display screen 340 includes a tabular(in this instance) arrangement of stored numerics arranged in a table,allowing the user to navigate through a predetermined period (e.g., 24hours) of stored trends with entries for time, heart rate/pulse rate,NIBP, respiration and pulse oximetry provided beneath each correspondingtext identifier. According to this embodiment, trend data is listed inone minute intervals for each of time, heart rate/pulse rate,respiration, and SpO₂, respectively, when any NIBP readings aresuccessfully made using the NIBP start/stop button 112 or throughautomated mode, or when an SpO₂ spot check reading is made. Each of thelatter features are described in a later portion herein. As will also bedetailed in a later portion of this description, the time intervalbetween trend entries is a configuration setting of the monitoringdevice 20 that can be selectively adjusted by the user, for example,depending on the patient.

The exemplary display screen 340 is configured to list seven (7) entriesin the display panel 360 according to the present example, although thisparameter can be varied. For example, and as shown in FIGS. 19 and54-56, a twelve (12) entry table is provided on a tabular trend datadisplay screen 470. No waveform data is provided on this screen 470,which is defined by a status panel 320, a trends live numerics panel356, similar to that shown in FIG. 18, and a trends data panel 474. Asnoted, up to 24 hours or other predetermined time period of trend datacan be stored into memory. A scrolling navigation icon 374 is alsoprovided next to the time listing in order to permit the user to accessany of the stored data, as needed.

In addition to tabular data, the herein described device 20 can displaytrended data in a graphical form. An exemplary graphical trend datadisplay screen 380 is shown in FIG. 57. This display screen 380 isdefined by a format that includes a status panel 320, as describedabove, a live trends numerics panel 356, and a graphics display panel384 with graphical trend data 294 having a time scroll 388 at the bottomthereof. The data shown pertains to a single parameter (in this example,heart rate), wherein the parameter data being displayed can be varied,as described in greater detail below.

Referring to FIGS. 18, 19 and 56, user-captured snapshots are identifiedseparately in the tabular listing of trend data with a camera icon 477.A sample snapshots viewing screen 298 is shown in FIG. 50. Reviewing ofsnapshot data is discussed in a later portion of this description.

The display button 104 according to the herein described embodiment isused to cycle through the configured display formats. As shown in FIG.19, the display modes can be toggled between large numeric displayscreens, waveform/numeric display screens, and trend data displayscreens. According to this example, pressing the display button 104allows the user of the monitoring device 20 to toggle between a largenumerics display screen 336, a single waveform display screen 210, and atabular trend display screen 470, respectively. Depending on theconfiguration settings of the herein described monitoring device 20, thedisplay button 104 could be used to navigate between each of the displayscreens shown in FIGS. 15, 17 and 18, respectively, wherein a defaultversion of each type of display screen can be determined.

In terms of overall navigation with regard to any of the above primarydisplay screens and in general according to this embodiment, the displaycursor, as referred to above, is always highlighted. Referring to FIG.21, and looking at an exemplary display screen, in this case a dualwaveform display screen 332, each and every display screen according tothis embodiment includes a single element—the current context—labeledherein as 407, that is shown by a first colored field (e.g., blue) inorder to highlight the element.

Using the user interface 92 of the herein described monitoring device20, pressing the SELECT button 96 causes the monitoring device 20 toreplace the current display screen with another display screen that isrelated to the current context. By way of example, if the SpO₂ textidentifier is highlighted in the display screen 332 of FIG. 21, and theSELECT button 96 is pressed, the monitoring device 20 is programmed tothen display a SpO₂ control menu 402, having a specified format andshown in FIG. 22, onto the primary display screen. The directionalbuttons 100 can be used to scroll the display cursor in order tohighlight the item to be selected by the user.

In addition, there are at least some display screens that also containelements—parameter values—that are highlighted by a second colored field(e.g., green). In the case of the second color highlighted areas, thecurrent values of multiple parameters are identified within a givencontext. For example and in the control menu display screen of FIG. 22,the current context of the SpO₂ monitoring menu option 403 ishighlighted in the primary or first color (e.g., blue), while thecurrent settings 404 of the SpO₂ parameters according to this embodimentare highlighted in the second color (e.g., green). Control menus andother menus are discussed in a later portion of this description.

In passing, other forms of indications can be provided on a displayscreen to a user using various colors or are provided with separateindicators in accordance with this embodiment. For example, items listedin red as shown in the display screen of FIG. 20 indicate readings 396that exceeded a given alarm limit (either an upper or a lower limit) inaddition to the current context 392, for example. Other examples areprovided. For example, the trend tabular display screen 470 presented inFIG. 56 depicts a number of readings 475 that have been compared toknown limits and have been suitably identified.

In addition to the display button 104, the herein described monitoringdevice includes a set of embedded menus that are used for at least twopurposes. First, certain menus (e.g., context menus) permit the user tonavigate between various modes of the monitoring device 20. Second,other menus permit adjustments to be made to the monitoring device 20.These adjustments are intended to be temporary and typically relate tothe specific patient being monitored. As previously noted, devicesettings are typically configured through factory default settings. Atechnique using a configuration file using the charging cradle 140 as anintermediary relative to a portable computer 192, FIG. 6, has also beendiscussed as an option to permit at least some of the factory settingsto be overridden. The monitoring device 20 further permits customconfiguration at the user level using a variety of display menus thatcan be accessed through the user interface 92. For purposes ofexplanation herein, two (2) main types of menus can be accessed, pop-up(also referred to throughout the discussion as drop-down) menus andcontrol menus. Each of these menus will now be described with regard tothe present embodiment. Other menus assist in navigation through andbetween various display screens in addition to the herein describeddisplay button 112. These menus have been alluded to with regard to thestart-up display screens, FIG. 24, and information screens, FIG. 27,noted above and are referred to as context menus.

First, pop-up or drop down menus are provided to allow a user totemporarily make configuration settings for the herein describedmonitoring device 20 as well as to vary certain formats, for example,for display. The menus also affect various modes of the device, amongother features, as will now be described. In brief, the display cursoris used to highlight an item in any primary display screen 210, 332,such as shown in FIGS. 15, 16, using the directional buttons 100 of theuser interface 92 and the SELECT button 96 is pressed to access acorresponding drop-down menu. As shown, for example, in FIG. 53, theresulting pop-up or drop down menu appears as an overlay onto theprimary display screen 590 wherein the format of each corresponding menuincludes a header text and a plurality of listed menu items or options.According to this embodiment, there are at least ten (10) drop downmenus available for the herein described monitoring device 20, each ofwhich enable certain settings of the device to be temporarily alteredfor a particular patient.

A patient mode drop down menu 540, FIG. 29, is accessible byhighlighting the displayed patient mode field 224 as provided on anyprimary vital signs display screen 210, FIG. 15, in the status panel 320thereof and pressing the SELECT button 96. The current or defaultpatient mode 544, in this case, an Adult mode, is highlighted and thedirectional arrow buttons 100 of the user interface 92, FIG. 2, enablethe mode to be changed to pediatric mode, shown as 556. When a patientmode is changed according to this embodiment, all stored vital signsdata, including any snapshot and trended data, for the patient isdeleted automatically from the CPU 174 and all monitoring devicesettings revert to the default settings for the new patient mode that isselected. Therefore and when changing a patient mode, a confirmationscreen 550, see FIG. 30, appears as an overlay on the display screen,shown herein as 554, indicating that parameter values will be changed todefault settings for the mode now selected and further indicating thatall stored information will be lost if the patient mode is changed.Confirmation is then required before any new mode selection can beimplemented by the user wherein confirmation changes the patient modeand removes the confirmation message panel 550 from the display screen554. The resulting display screen (not shown) then indicates pediatricin the patient mode field 224 thereof.

As noted previously and referring to FIG. 6, the monitoring device 20includes a wireless RF radio card 180 and internal antenna 182 whichwhen enabled, automatically establishes a wireless communications linkbetween the monitoring device 20 and the central monitoring station 184.While within the confines of a wireless LAN (Local Area Network), thisconnection is suitable within range of a suitable access point 186. Thecommunication status indicator or icon 212 located on the status panel320 of any primary display screen 210, such as those shown in FIG. 15,is configured to provide an indication of the status of the wirelessconnection with the remote monitoring station 184, which is limited, forexample, given the distance between the monitoring device 20 and anaccess point 186 on the network. For example, if the status indicator212 is blank, according to this embodiment, then the monitoring device20 is not enabled for communication with the remote monitoring station184. This status indicator 212 can provide certain informationconcerning the connection as follows according to this embodiment: Ifthe communication status indicator 212 flashes, this is an indicationthat the monitoring device 20 is associated with an access point 186,but the device is not communicating with the remote monitoring station184. If the communication status indicator 212 has a line appearingthrough it, the indicator being presented as shown in FIGS. 15-18 as anantenna symbol, then the monitoring device 20 is not communicating withan access point 186, FIG. 6, and is not communicating with the remotemonitoring station 184. As previously noted, the communication statusindicator 212 according to this embodiment is located at the upper righthand corner of the status panel 320 in any primary display screen.Similar indications can be made using the status indicator 212 when themonitoring device 20 is communicating with a PC 192 and not with thenetwork, and whether the monitoring device is associated with thenetwork and is communicating with the remote monitoring station 184.

Due to battery constraints it is desirable when the monitoring device 20moves out of range of the access point 186, that the user canselectively disconnect the monitoring device 20 from the wirelessnetwork and place the device in a disconnected wireless mode. Thisselective disconnection is highly desirable given the considerable drainto the battery resources that occur when attempting to restorecommunications with the remote monitoring station 184, FIG. 6, as thedevice would continue to attempt to restore communications even when thedevice is out of range. According to one version according to thepresent invention, this selective disconnection is achieved throughsoftware wherein the user highlights the communications status indicator212 of primary display screen 210, FIG. 15, or any display screen havinga status panel 320 using one of the directional arrow buttons 100pressing the SELECT button 96.

According to this embodiment and referring to FIGS. 48 and 49, adisconnected wireless icon popup or drop-down menu 560 (if the device isenabled with a wireless transceiver 180 and antenna 182) is accessed bywhich the user is permitted to selectively toggle into and out of adisconnected wireless mode.

The pop-up menu 560 includes a set of menu options, including adisconnect option 564 which the user can elect to disconnect themonitoring device 20 from the wireless network by scrolling using theappropriate directional arrow buttons 100 and highlighting thedisconnect menu option. This election is further indicated to the userby one of the status indicators 169, FIG. 2, provided on the frontfacing side 84 of the monitoring device 20. During the time that themonitoring device 20 is disconnected from the network, the deviceprovides only local respiration, NIBP, HR/PR and SpO₂ alarms orequipment alerts. During that time, a Disconnect message 568 is alsodisplayed to the user next to the communication status indicator 212 onthe display screen 210, the latter having a symbol indication ofdisconnection, as shown in FIG. 49. The use of the disconnect featureprovides an advantage in that battery/device power is conserved whilethe monitoring device 20 is out of range. During the time the abovewireless disconnect feature is utilized, trended vital signs datacontinues to be stored within the memory of the CPU 174, as per normaloperation.

When the monitoring device 20 is again within range of the network, thecommunication status indicator 212, FIG. 15, provides a signal that themonitoring device 20 is within range and network connection can berestored by again highlighting the communication status indicator 212 toaccess the wireless mode menu 560, highlighting a Reconnect menu option(not shown), and pressing the SELECT button 96. This selectionautomatically causes a prompt that is displayed to the user forinformation concerning the patient and the network. A similar message isdisplayed at the remote monitoring station 184. Reconfiguration andhandshaking of the herein described monitoring device 20 with thewireless network is as described in the previously incorporated U.S.Pat. No. 6,544,174. At the time network connection is restored, alltrended data stored during the time the monitoring device 20 wasdisconnected is transmitted to the remote monitoring station 184, FIG.6, over the wireless network.

While the wireless version of the herein described monitoring device 20is connected over the network, patient data gathered by the monitoringdevice is continuously stored at the remote monitoring station 184. Atthe remote monitoring station 184, patient information can be accessedand administrative functions can be performed including admitting,transferring and discharging the patient from the remote centralmonitoring station unit, editing the patient description (name, primarycare physician), and reviewing and printing patient data, includingtrends and waveforms.

Other pop-up or drop-down menus are provided according to thisembodiment for temporarily configuring other settings of the monitoringdevice 20 include a waveform source popup menu 580, see FIGS. 32, 33,that provides user selections for determining which waveform is beingdisplayed (e.g., resp, ECG including choice of vector) and forswitching, for example, between a single waveform display screen 210 anda dual waveforms display screen 332, FIG. 16. This latter menu 580 isaccessed by the user by highlighting the waveform source field 232 onthe display screen 210 and pressing the SELECT button 96. According tothe present embodiment and for all waveforms, except respiration, themonitoring device 20 further includes means for cascading a display inorder to sweep a single waveform through two panels, thereby showing orpresenting a waveform covering a 2.times. time period (e.g., 6 secondsto 12 seconds). FIG. 32 illustrates an example ECG waveform having adefault menu option 584, with FIG. 33 depicting a user option 588 for arespiration waveform using the menu 580.

Similarly, a waveform size drop-down menu 600, FIG. 34, permits userselection relating to the size of displayed ECG, SpO₂ or respirationwaveforms relative to any display screen 332 by highlighting thewaveform size text identifier 236, located in the waveform panel 344 andselecting a menu option 604. A sample respiration waveform 608, FIG. 37,is shown that is augmented by this size menu.

A trend display pop-up menu 640, FIG. 53, permits selection betweenvarious forms of trended data (tabular, waveform, snapshot) byhighlighting the data display header 364, FIG. 52, in the trends livenumerics panel 356, FIG. 52, of a trended display screen, in thisinstance, a snapshots display screen 590. As previously noted, tabularscreens are shown in FIGS. 54-56 and a graphical trend display screen380 is depicted in FIG. 57.

Similarly, a trend view interval popup menu 660, FIG. 55, is accessed byhighlighting the Time heading in the data display panel 474, the menupermitting the time intervals between trended data listed to beselectively varied by the user.

Additional pop-up menus according to this embodiment include a snapshotwaveform source popup menu, a graphical source pop-up menu and asnapshot selection pop-up menu. Each of these embedded menus aresimilarly accessed by highlighting the appropriate text identifier andpressing the SELECT button 96 to affect temporary configuration settingchanges for the device 20. In addition, an SpO₂ spot check or randompop-up menu 620, FIG. 41, is also provided, details being provided forthis latter feature in a succeeding section.

A “control” menu for purposes of this embodiment includes a topic namefor the current context (for example, SpO₂, in FIG. 22), each menu beingdefined by a stored formatted template comprising a first display panelhaving a column of parameters with one of the parameters highlighted(for example, SpO₂ Monitoring), and a column of options, with one itemin the set of options being highlighted (for example, Standby, On, 100,On, 90, Low). The primary (e.g., blue) highlighted item indicates theparameter that is currently enabled for modification, while secondary(e.g., green) highlighted items indicate each of the current settingsfor all parameters in the control menu. Each control menu furtherincludes a context menu at the bottom of the control panel in order toenable navigation as well as permit confirmation or cancellation of achoice/option selected by the user, such as in the instance of thestart-up display screens 400(a), 400(b), FIG. 24. Presently; themonitoring device 20 described herein includes at least nine (9) controlmenus that are accessible by the user.

As noted, each control menu can provide customization of theconfiguration of the monitoring device 20 for the current patient and toconfirm choices. As in the preceding, each control menu can be accessedusing the directional arrow buttons 100 to locate and highlight the itemto be controlled and pressing the SELECT button 96, as previouslydescribed. It will be readily apparent that the number and arrangementof these menus is exemplary and that other variations and modificationsare possible within the intended ambits of the invention. Additionally,it should further be noted that each of the following controls can besimilarly modified from the remote monitoring station 184 over thewireless connection with the monitoring device 20.

First, a time setup control menu 700, FIG. 31, allows the time, date andtime format used by the monitoring device 20 to be locally modified bythe user. More particularly and according to this embodiment, the timeformat (12 hour/24 hour), hour, minute, month, day, year, year and yearformat can be selectively adjusted by the user. The time and date canalso be confirmed for correctness as the monitoring device 20 is capableof displaying time in either 12 hour (AM/PM) or 24 hour format, anddisplays the date in either a month/day/year, day/month/year, or othersuitable format. According to this embodiment, the date does not appearin the primary display screens but does appear in both a snapshot listand associated snapshot data, details of which are described below.Highlighting the time display 216 (located in the upper right corner ofa primary vital signs display screen 210 or any display screen having astatus panel 320) and pressing the SELECT button 96 to accesses theTime/Date control menu 700, the screen allowing changes to be made andstored into memory by the monitoring device 20.

Additionally, a number of parameter control menus are accessible,including an NIBP control menu, an SpO₂ control menu, a HR/PR controlmenu and a respiration control menu, respectively. Each of theseparameter control menus can be accessed by either selecting theparameter text identifier in any primary display screen such as 210,FIG. 15, or by selecting the alarm bell icon 268.

More specifically, the NIBP control menu permits the setting of upperand lower alarm limits for each of the systolic, diastolic and meanpressures as well as the selection of a digital manometer, the selectionof a specific NIBP mode and the time interval used when an automaticmode is enabled. An exemplary NIBP control menu 720 is shown in FIG. 23.The NIBP control menu 720 is defined by three panels according to thepresent embodiment. The uppermost panel 722 includes a listing of menuoptions that can be elected by the user. The second field 724 includes alisting of submenu options associated with each menu option from thefirst panel 722. The third panel is a context menu panel 416 thatincludes a series of navigational options.

More specifically with regard to the herein described monitoring device20, NIBP measurements can be taken through a user-selected automaticmode in which blood pressure readings are taken at prescribed timeintervals. Following the correct positioning of a proper sized cuff 76,FIG. 1, on a patient, and screwing the hose end into the NIBP airconnector fitting 48, FIG. 3, provided on the top facing side 52 of thedevice housing 24, FIG. 3, the automatic NIBP mode can be enabled byhighlighting the NIBP text identifier in the primary vital signs displayscreen 210, FIG. 15, and pressing the SELECT button 96. The aboveselection accesses the NIBP control menu 720, shown in FIG. 23, whereinthe NIBP Mode option is scrolled to and the Auto menu suboption in thesecond panel 724 is selected using the directional control buttons 100to highlight the desired mode and pressing the SELECT button 96. Anappropriate time interval can then be selected by highlighting the AutoTime Interval (min) suboption in the panel 724 that will provideautomatic blood pressure measurements at the prescribed intervals (e.g.,3 min, 5 min, 15 min, 30 min, 60 min, etc). It should be noted that theincorrect placement or failure to place the cuff 76 on the patient willstill enable automated mode, but an equipment alert will be sounded bythe monitoring device 20.

The automatic NIBP mode can be disabled by highlighting the NIBP textidentifier on the primary vital signs display screen 210 using thedirectional control buttons 100, pressing the SELECT button 96 to accessthe NIBP control menu, FIG. 23, and then highlighting NIBP mode from theNIBP control menu 720 and selecting the Manual menu option using theappropriate directional control buttons 100.

Otherwise, any blood pressure reading can be taken manually afterpositioning the correct cuff 76, FIG. 1, and hose 80, FIG. 1, relativeto the patient, screwing the hose end into the NIBP air connectorfitting 48, FIG. 3, provided on the top facing side 52, FIG. 3, of thehousing 24 and pressing the NIBP start/stop button 112. As previouslynoted, all manual and other NIBP mode measurements are stored as trendeddata by the monitoring device 20.

In addition, an enhanced blood pressure measurement mode (hereinreferred to as “Turbo” mode) is provided in which the monitoring device20 automatically initiates a blood pressure measurement reading in aconventional manner and then takes as many readings as is possiblewithin a predetermined time period (e.g., 5 minutes), provided thisoption is enabled by way of default configuration settings such asthrough the downloaded configuration file. Turbo mode, as definedherein, can be set through the user interface 92 by highlighting theNIBP text identifier in any primary vital signs display screen 210 andpressing the SELECT button 96 to access the NIBP control menu 720, FIG.23, as previously described. The NIBP Mode menu option can then behighlighted with the Turbo suboption then being selected using theappropriate arrow button 100. Selecting the NIBP start/stop button 112or highlighting the NIBP Mode Manual menu option from the NIBP controlmenu 720 will restore the monitoring device 20 to a manual NIBPmeasurement mode.

As noted generally above, the patient monitoring device 20 according tothe present embodiment further includes a digital manometer that can beselectively displayed for the user during a blood pressure measurementprocedure. This feature is enabled through the NIBP control menu 720which is accessed in the manner previously described above from any ofthe primary vital signs display screens. In the NIBP control menu 720,FIG. 23, the Manometer option listed therein in the top panel 722 ishighlighted using the directional arrow buttons 100. Pressing the SELECTbutton 96 causes a manometer menu 730 to appear as an overlay on thedisplay screen 210, as shown in FIG. 44. Pressing the NIBP start/stopbutton 112 starts the NIBP measurement cycle as previously described.When the attached cuff 76, FIG. 1, is inflated, a manometer pressureindicator bar 734 located at the bottom of the display screen 210dynamically displays the pressure reading, as shown in FIG. 45. When theblood pressure measurement cycle is completed, measurement numerics 742appear below the waveform grid of the display screen 210 and each of thesystolic, diastolic and MAP values for the measurement are displayed asmarkers 738, if valid readings are obtained for each along a definedmanometer scale, as shown in FIG. 46.

Adjustment and enablement of the alarm limits and the remaining optionson the control menu 720 are selected in the same manner described above.As to the context menu panel 416 options for parameter control menus andreferring for example to FIG. 44, the Exit menu option, if selected bythe SELECT button 96, reverts the user back to the previous primaryvitals signs display screen, the Trends option changes the displayscreen to a trends viewer screen that causes a tabular or waveformhistory to be displayed, the Snapshots menu option causes a series of21-second waveform snapshots of the current patient's vital signs to beselectively viewable, and the Setup menu option accesses the setupcontrol menu.

The SpO₂ control menu 402, FIG. 22, permits setting of either continuousor a random (herein also commonly referred to as a spot-check) SpO₂measurements, the setting of alarm limits and setting of the pulse tone.According to the present embodiment, continuous measurement of at leastone physiologic parameter other than SpO₂, such as ECG, is enabledthrough the CPU 174 and the tethered physiologic parameter sensorassemblies, while permitting the user, by means of the user interface92, to manually “spot check” SpO₂. That is to say, SpO₂ can beperiodically or randomly checked on the patient (not shown) whilesimultaneously maintaining continuous monitoring of at least one otherphysiologic parameter.

When continuous SpO₂ is enabled, an alert is generated each time thatSpO₂ readings are interrupted, such as when the sensor is disconnectedfrom the patient after the monitoring device 20 has begun to take SpO₂readings. Using the random monitoring or “spot check” feature, anynumber of randomly taken readings can be taken, attaching and detachingthe sensor repeatedly without generating any alarms.

Referring to FIG. 39, a flowchart generally describes the hereinreferred to random or spot checking monitoring feature. Initially, theSpO₂ monitoring function of the monitoring device 20 is turned off. Theuser can turn the continuous SpO₂ monitoring function off manually withthe user interface 92 by scrolling to the primary vital signs displayscreen, FIG. 21, and highlighting the SpO₂ text identifier 407 andpressing the SELECT button 96. The preceding accesses the SpO₂ controlmenu 402, FIG. 22. This control menu 402 is defined by two panels; afirst panel 746 that includes a list of menu options and suboptions anda context menu panel 416 permitting navigation out of the spot-checkmode. Highlighting the SpO₂ Monitoring menu option 403, using the leftarrow button 100 to highlight the Off suboption and pressing the SELECTbutton 96 then turns off the continuous monitoring function and turnsthe spot checking feature.

When the SpO₂ monitoring function has been deactivated, it can then bereactivated by the user, either for continuous monitoring or for aone-time spot check reading. When a spot check is desired according tothis embodiment, the pulse oximeter sensor 60, FIG. 1, is attached tothe monitoring device 20 and to the patient. The user then highlightsSpO₂ on the primary vitals sign display screen, FIG. 40, and presses theSELECT button 96. Upon pressing same, the user then highlights SpO₂ @XX:XX and presses the SELECT button 96 accessing a SpO₂ drop-down menu620, FIG. 41. This menu 620 that appears as an overlay onto the displayscreen (not shown in this view) includes On, Off and Spot Check options.The On option 622 permits the user to reenable the continuous SpO₂monitoring feature. The Off option 624 disables the continuousmonitoring feature and enables spot checks. The Spot check option 626 ishighlighted in this instance, since the SpO₂ continuous monitoringfunction has already been disabled. The spot checking feature of theherein described monitoring device 20 is controlled through logiccontained within the monitoring device 20 that allows the SpO₂ hardwareto first initiate the sensor assembly 32, FIG. 1, and acquire a stableSpO₂ measurement from the patient as sensed by the apparatus. Accordingto this embodiment and referring to FIG. 42, the primary vital signsdisplay indicates SpO₂ Spot Check with a text identifier “SEARCH” 628displayed above a Spot Check text identifier 629 to indicate that themonitoring device 20 is waiting for pulse oximetry data from thepatient. After a few seconds, the SpO₂ indicator (if SpO₂ is used todetermine pulse rate begins to display pulses and after approximately 30seconds, the SEARCH text identifier 628 disappears and a pulse oximetryreading 256 appears, FIG. 43. Once a stable measurement has beenacquired, the SpO₂ subsystem is powered down automatically. The stableSpO₂ reading that has been obtained is then displayed for apredetermined period of time or until a new spot check reading of SpO₂is acquired. For additional spot checking, the preceding steps are thenrepeated wherein the SpO₂ sensor assembly 28 is initiated; a stablereading is acquired and then displayed for a predetermined period oftime. In the meantime, any other parameters that are continuouslymonitored, such as ECG, are unaffected by the spot-checkingfunctionality feature.

Each of the HR/PR and respiration control menus as well as the NIBP andpulse oximeter control menus permit the setting of upper and lower alarmlimits. The HR/PR control menu (not shown) further permits adjustment ofvolume or enablement of the heart tone, and the preferred source (eitherSpO₂ or ECG) for heart rate wherein the current source is alsohighlighted. The respiration control menu (not shown) also permits theselection of the reference leadwire used from the ECG monitoringassembly.

In addition to the above parameter control menus and the time setupcontrol menu, set-up control menus are also provided to the user inorder to define the behavior of the herein described monitoring device20. A typical set-up menu can be accessed according to this embodimentfrom any main display screen, such as those depicted in FIGS. 15-19, byperforming the steps of: highlighting the battery indicator icon 220,HR/PR text identifier, SpO₂ text identifier, NIBP text identifier,respiration text identifier or the alarm icon 268; pressing the SELECTbutton 96 thereby accessing a parameter control menu; highlighting thesetup option located in the context menu panel 416 at the bottom of thedisplay screen 210; and pressing the SELECT button 96 again.

Among the items that can be configured in the respective set-up controlmenus according to this embodiment are the suspension and enablement ofthe audible alarms and adjustment of alarm tones, permitting managementof same in a patient context. As previously noted, an “alarm” warns of apatient condition, such as a vital-sign reading that is outside ofacceptable limits. When an “alarm condition” occurs according to thepresent embodiment, the red light status indicator 169, FIG. 2, on thefront facing side 84 of the monitoring device 20 flashes and thenumerics of the violating alarm limits shown on the display 88 turn red,such as depicted in FIG. 20. In addition, the display cursor movesautomatically to the displayed item that caused the alarm and if notsuspended, an audible alarm tone also may sound. A sample alarmcondition 850 is shown in FIG. 58 in a single waveform display screen210. In this instance, the heart rate for the monitored patient hasexceeded a predetermined limit, as highlighted by 854. In addition tothe above and in the instance that the monitoring device 20 is connectedto a remote monitoring station 184, FIG. 6, notification of the alarmcondition may also be transmitted to the remote monitoring station.Pressing the alarm silence/resume button 112 will silence current alarmtone for a predetermined period of time (e.g., 90 seconds).

An “alert” refers to an equipment or device condition, such as a lowbattery or a detached lead. When an “alert condition” occurs, the yellowlight indicator 169 on the monitoring device 20 flashes and a messagedescribing the condition appears on the display 88 in a message panel.An example of an equipment alert, in this instance, the disconnection ofan ECG lead, is shown by the display screen of FIG. 59. Equipmentalerts, according to this device embodiment, are indicated by a flashingyellow indicator 169 as well as a highlighted (e.g., yellow) alertmessage 306 provided conspicuously on the display screen of themonitoring device 20 and repeated sounding of an alert tone, in theinstance that the alert is not acknowledged or the cause of the alert isnot alleviated. The knowledgement is made through a context menu locatedat the alert window screen. Preferably, an alert tone will bedistinguishable from an alarm tone to a user. In this specific instance,the depicted equipment alert is an ECG lead failure. Therefore and inaddition, a diagram 302 is illustrated with an indication (in thisinstance a circled X) to indicate at least one disconnected lead. Alarmand alert conditions can also be detected by the remote monitoringstation 184, FIG. 6, via the wireless network.

Examples of alert conditions detected by the herein described monitoringdevice 20 include, but are not limited to, the following: ECG Faultswhich can include Lead failure (single, multiple), excessive offset, ordetection of unplugged ECG cable; NIBP Faults that can include an airleak, kinked hose, overpressure cuff condition, weak pulses to determinesystolic/diastolic pressure, no pulses detected, detection of artifactprevents valid reading, or low battery; Network Communication Faultsincluding the detection of a network communication problem, detection inattachment to charging cradle, low battery, or no SpO₂ detected; andrespiration channel faults, such as a noisy signal or lead failure.Still referring to FIG. 59, acknowledgement of the alert by the user ismade by highlighting the acknowledge option 864 at the bottom of thedisplay screen and pressing the SELECT button 96, FIG. 2.Acknowledgement will remove the message panel and revert the display 88to the previous display screen format.

Equipment faults for those situations in which the herein-describedmonitoring device 20 is operating on battery power as opposed to beingmounted in the charging cradle have been discussed previously. In lowbattery conditions in which less than approximately 30 minutes ofbattery runtime remains, NIBP functions are disabled and the monitoringdevice 20 displays an appropriate message to the user that NIBP isdisabled. Any attempt to press the NIBP start/stop button 112 orotherwise initiate a blood pressure measurement during a low batterycondition will display an equipment alert with an appropriate message.However, placing the monitoring device 20 into the charging cradle 140during a low battery condition will immediately enable all bloodpressure monitoring features.

There are two techniques according to the present embodiment in ordertemporarily silence an alarm tone. The first technique is throughpressing the alarm/silence button 108, which will silence any currentalarm(s) for a predetermined period of time (e.g., 90 seconds). Itshould be noted, that silencing the audible tone does not affect theremaining alarm or alert indicators. The alarm tone can also, accordingto this particular device embodiment, be suspended for all parameters,thereby preventing the alarm tone from sounding if an alarm conditionoccurs while monitoring a patient. Suspension is done by the userthrough accessing an alarms suspend menu 880 that is provided in the setup controls menu 800, as shown in FIGS. 60, 61. If an alarm conditionoccurs while the alarm tones are suspended, the monitoring device 20presents visual alarm indicators, but does not sound an audible tone.

As opposed to the interval for silencing an alarm tone, the suspensionperiod of the alarm tone can be set during configuration of themonitoring device 20 to disable the tone for a predetermined period(i.e., 90 seconds-60 minutes). In addition, the monitoring device 20 canbe so preconfigured such that the alarm tone cannot be suspended by theuser, for example, through use of the configuration file that isuploaded to replace the factory settings of the monitoring device usingthe PC 192, FIG. 6, as previously described.

Referring to FIGS. 60, 61, and if the suspend feature is not disabledfor the present monitoring device 20, the user can access the set-upcontrol menu 800 by highlighting the text identifier of the parameterthat is highlighted by the alarm. Once in the set-up control menu 800,the user can highlight the Alarms option, thereby accessing the Alarmsset-up menu 880. As shown in FIG. 60 and upon accessing the Alarms setupmenu 880, the display cursor highlights the Off menu option wherein amessage panel appears in the display screen 210 to use the directionalright arrow button 100 in order to highlight the On suboption. Oncesuspension has commenced, FIG. 61, a count-down timer 884 appears belowthe line in the set-up menu 880 as well as a highlighted indicator 888in the upper portion of the display screen 210. When the suspensionperiod expires, the alarm tone is again enabled. The alarms set up menu880 further permits the volume of the alarm tone to be selectivelyadjusted by the user.

Typically, each medical facility defines the patient alarm limits foradult, pediatric and neonatal patients and then configures themonitoring device 20 with those alarm limits prior to putting themonitoring device into service. As previously noted herein, it was notedthat the user can locally or custom adjust certain configurationsettings of the herein described monitoring device 20.

According to another feature of the herein described patient monitoringdevice 20 and referring to FIG. 62, upper and lower alarm limits can betemporarily customized for an individual patient while the monitoringdevice 20 is in use. This temporary customization feature can beimplemented by the user by highlighting any vital sign of interest froma primary vitals signs display screen and pressing the SELECT button 96so as to access the control menu for that parameter; in this instance,NIBP, 720. Upper and lower alarm limits can then be selected byhighlighting the current value and using the left and right directionalarrow buttons 100 to set the new alarm limit(s), 726, 728. These newlimit values are then stored in volatile memory of the CPU 174, FIG. 6,of the monitoring device 20 and are erased when the monitoring device ispowered down unless the user specifically maintains them as part of thecurrent patient. Alternatively, however, the device could be configuredto allow a user such that the settings could be retained by the userirrespective of the patient. The monitoring device 20 is furtherconfigured to permit alarm limits to be customized for a particularpatient from the remote monitoring station 184, FIG. 6, over thebidirectional wireless network using the radio card 180 and antenna 182to receive new limit values.

In addition to the above features, the herein described monitoringdevice can be further configured such that the user can perform alarmmanagement on the monitoring device 20 by permitting the user to actuatea feature provided on the user interface 92 that creates a predeterminedpercentage change to the alarm limits for a single parameter each timethe SELECT button 96 is depressed at the time of an existing alarm. Theinitialization and initial percentage settings for each of the alarmparameter settings is performed according to this specific embodiment aspart of the configuration of the monitoring device 20 prior to use ofthe monitoring device 20 through the PC 192 using the configuration fileto override factory configuration settings, the new settings beingstored by the CPU 174. A portion of a sample worksheet 198 is shown inFIGS. 64, 65 in which factory settings 199, shown in bold, can beadjusted for specific parameters, as listed in FIG. 64. Completing theworksheet 198 through the utility thereby provides means for completingthe configuration file and assigning preset percentage amounts foradjusting alarm limits for any single parameter during a currentalarm(s). The worksheet includes a menu choice 197 for enabling thealarm limit percentage option herein, also referred to as ParamSet. Inessence, the user of this selective alarm management setting featurepermits both upper and lower alarm limits to be preset accordingly andthen used selectively by the clinician/nurse.

In summary, four (4) techniques are now provided in the presentmonitoring device 20 for handling or managing an existing alarm: First,the user can temporarily silence an alarm through use of the alarmsilence/resume button 108 provided on the user interface 92. Turning thealarm off temporarily, however, in and of itself, does not change thelimit. Therefore, if the patient's physiologic parameters are unchanged,the alarm will go off again momentarily depending on the defaultsettings of the monitoring device 20 (e.g., 90 seconds). Second, theuser can suspend the alarm tone for a patient for a predetermined periodof time in the manner described above using the control menus 800. Thisfeature also does not change any alarm limits. Third, the user cantemporarily change or customize any of the alarm limits individuallythrough features provided on the user interface 92, using the set-upcontrol menus, as described above, such as 720 or other menu. As noted,this third technique can be accomplished by accessing the control menufor a specific parameter to highlight a specified parameter indicator(such as HR/min or NIBP, for example) and pressing the SELECT button 96.The corresponding parameter control menu, FIG. 62, is then displayed,permitting the user using the directional left and right cursor controlbuttons 100 to set appropriate alarm limits for the patient, the userthen highlighting Exit to leave the menu window. Using the same pop-upmenu or a similar menu, a fourth technique is provided by means of thepresently described vital signs monitoring device 20 in which the usercan also now automatically and selectively change a parameter alarmlimit by a prescribed amount. Rather than incrementally changing thealarm limits, the user can change the alarm limits by a prescribedpercentage amount each time the SELECT button 96 for this option isactuated as entered using worksheet 198, FIG. 64, via the configurationfile. The latter feature can be accessed only during a current alarm(s).For example, upper and lower alarm limits for HR/PR can initially be setto alarm at an upper rate of 90 and a lower rate of 60. Using the latterfeature, each time the SELECT button 96 is actuated for the abovefeature in the control menu, the alarm limits can be incremented by apredetermined percentage (e.g., 5 percent, 10 percent, or other). Forexample, if a five percent change were configured for the hereindescribed monitoring device 20, the alarm limits would change to 94(upper)/57 (lower) the first time the SELECT button 96 is depressed, 99(upper)/54 (lower) the second time the button is depressed, and soforth. Similarly, NIBP (systolic pressure, diastolic pressure and meanpressure), SpO₂ and respiration rate limits can be similarly adjustedwherein the amount from factory (default) preset value alarm limitvalues can be adjusted, depending on the patient mode, for individualparameters as part of the pre-configuration routine using the PC 192. Atabular listing 950 is shown in FIG. 65 for appropriate percentagechanges to the alarm limits according to one example.

The ECG monitoring sensor assembly 28, FIG. 1, of the present embodimentincludes a respiration circuit provided in the form of an ASIC, whereinbreath signals using impedance pneumography supports measurement ofrespiration rate as well as central apnea. The herein describedmonitoring device 20 can monitor heart signs (ECG) and respiration rateusing either a 3-lead or a 5-lead ECG cable. Using a 3-lead ECG cable,one signal waveform for lead I, II, or III can be displayed. Using a5-lead ECG cable, either one or two signal waveforms can be displayed bythe monitoring device 20 for leads I, II, III, V, and if enabled in theconfiguration, aVR, aVL, or aVF. The SpO₂ or Resp waveform can also bedisplayed in place of the ECG waveform.

To monitor ECG, the appropriate ECG cable is plugged into the devicehousing 24 and appropriate electrode sites are selected on the body ofthe patient. This selection process is commonly known and does not forma significant part of the present invention. At least three (3)electrode connections are required for ECG/Resp monitoring. Themonitoring device 20 provides a graphic display 302, FIG. 59, of a threeor five lead ECG attachment with fixed locations being indicated. Thelocations of the circles shown in the diagram 302 in FIG. 59 do notindicate the exact placement of the electrodes on the patient.

The monitoring device 20 is adapted to indicate whether some lead wiresare not connected and to indicate an “ECG Fault” equipment alert and achest diagram such as shown in FIG. 59, indicating the general locationof the disconnected lead or leads. If the disconnected lead(s) indicatethat the waveform source (Lead) used for HR determination, then themonitoring device 20 automatically reassigns, if possible, the Lead usedfor heart rate (HR). If the reassignment succeeds, the monitoring device20 then displays another equipment alert with the message “ECG Leadchanged”.

When all leads are properly connected, returning to the primary vitalsigns display screen will confirm that an ECG waveform is beingdisplayed as well as heart rate and other patient data. The waveformsource can be changed, for example, from Lead I to Lead II byhighlighting the waveform source selection icon using the cursor controlbuttons 100 and pressing the SELECT button 96. The latter will accessthe waveform source menu 580, FIG. 32, wherein the appropriate option584 can be highlighted. In passing and by scrolling to the bottom of thewaveform source choice menu, a second waveform can be added (ordeleted). The waveform size can also be suitably varied by the user byhighlighting the current waveform scale and pressing the SELECT button96. The waveform size pop-up menu 600, FIG. 34, is accessed through thelatter selection and a desired scaling factor can be highlighted.

Respiration rate is also monitored using the ECG monitoring circuit, asnoted above, based on impedance pneumography, wherein respirations canbe sensed from the ECG electrodes. The respiration numeric is displayedin the lower right corner of the display screen. To view the respirationwaveform, the waveform source identifier 232, FIG. 15, is highlightedand the SELECT button 96 is pressed in order to access the waveformsource pop-up menu 580, FIG. 33. Respiration as a menu option 588 isthen highlighted and selected. Waveform size can be adjusted in the samemanner described previously for the ECG waveforms.

In addition to monitoring the presence of the ECG waveform, themonitoring device 20 also detects the periodic signals emanating from animplanted pacemaker device. To that end, according to the presentembodiment and referring to FIG. 35, if the patient being monitored hasan implanted pacemaker device, the monitoring device 20 can indicate theoccurrence of pacemaker or pacer signals by activation of the PacerIndicator option 904 from the ECG set-up control menu 900, FIG. 36, ifnot already configured. When activated, the Pacer Indicator displays andprints vertical dashed lines to indicate pacemaker signals. If the PacerIndicator option 904 is not enabled, the monitoring device 20 accordingto this embodiment continues to detect the pacemaker signals, but doesnot display or print the pacer markers. If the pacer signal issufficiently strong, the monitoring device 20 displays this signal as awaveform spike, whether the Pacer Indicator option 904 is enabled ornot. The present ECG circuit also detects when pacer signals/EMI pulsesare occurring too frequently (outside of the periodicity of realisticpacer signals).

As previously noted, the detection of these pacer signals is commonlyaffected by electronic noise (such as EMI—Electromagnetic Interference)triggered, for example, from overhead lights that can hinder the abilityto adequately detect a pacer signal from an implanted patient device(i.e., a pacemaker). Electrical noise from a power source can also causean unclear or noisy waveform. According to one aspect, the inventionprovides the ability to select amongst the various ECG vectors, each ofwhich has been processed for pacer pulse detection of both polaritiesand feeds both the pacer pulse detector and a peak/noise floor detector.An example is shown in FIG. 63. The latter detector generally captures avalue 908 that is representative of the peak amplitude of real pacerpulses, and also captures a second value 912 that is representative ofthe peak amplitude of rapidly repetitive noise spikes, as shown in FIG.63. Means allow selection of available ECG vectors and after obtaining apeak and noise floor level signal from each, shown as 915, 916,respectively, then picking an optimum ECG vector to continue feeding thepacer pulse detector. If the noise floor signal is made available to theuser, the user can observe how the magnitude of the noise floor signalchanges while moving the monitoring device 20 about in the vicinity of apossible noise source, the latter being shown magnified as 918. Thereported signal level will generally increase as the monitoring device20 is moved closer to the noise source and hence serves a directionalaid in locating the source of electrical noise. Since it is alreadyknown at what level the noise spikes 912 would begin to trigger thepacer pulse detector, it may thus be determined whether a noise sourcewas sufficiently large to cause false pulse detections. The principlesdescribed herein can be implemented by hardware, software or acombination of hardware and software.

The above circuit can further be used to validate a measurement in orderto assess lead wire and electrode integrity for an ECG monitoringassembly. This measurement capability provides means for monitoringelectrode performance as well as providing a means for proactivelychanging electrodes, as needed. As a matter of background and when leadwires of an ECG monitoring assembly are attached to a patient, thehardware drives a small current through each connected lead wire. Thiscurrent is directed through the patient to a reference lead wire, alsoextending from the patient. As a result, each lead wire produces anoffset voltage (with respect to the reference lead) based on Ohm's Law.

According to a variant of the present invention, each lead wire's offsetvoltage delta (that is, the voltage difference between each of its leadwires) can be determined, thereby providing a means for qualitatively“ranking” each of the lead wires and electrode assemblies. Softwareincluded within the monitoring device can then be utilized in order toprovide an assessment of the electrodes and the lead wires based on thecomputed deltas, at least to determine the “qualitative state” of theelectrodes, (e.g., if one lead wire has a much higher offset than theremaining leads, the most likely cause is an electrode contact issuesuch as a dry electrode or loss of contact with the patient). Bycomparing ratios of these voltage differentials, it is thereforepossible to anticipate or become proactive relative to the life ofportions of the ECG monitoring assembly.

In addition to the above, the monitoring device 20 also includes a powersource filter that can be enabled from the ECG set-up control menu 900,FIG. 36. The settings for the power source filter should be applieddepending on the power source in the facility. To that end, the powersource filter option 906 according to this embodiment includes settingsof 60 Hz and 50 Hz.

Many factors can adversely affect a blood pressure (NIBP) measurementincluding cardiac arrhythmias, sudden changes in blood pressure, patientmotion such as convulsions or shivering, sudden cuff movement,vibration, vehicle motion, or a weak pulse, among others. According tothe present embodiment, and when NIBP and ECG are each being monitoredwith regard to a patient, the herein described monitoring device 20 canbe further equipped with the selective use of a motion artifact filter,such as the Smartcuf artifact filter manufactured by Welch Allyn, Inc.,in order to increase the measurement accuracy in the presence ofmoderate motion artifacts or diminished pulses. Specific detailsrelating to the specific motion artifact filter utilized by this deviceare described in U.S. Pat. No. 6,405,076 B1, the entire contents ofwhich have been previously incorporated by reference.

Enablement of an artifact filter feature would include the steps ofmounting each of the ECG and NIBP assemblies to the monitoring device 20and to the patient respectively and as previously described, and thensimultaneously monitoring the patient using each of the abovephysiologic sensor assemblies. The set-up control menu 800 would beaccessed in the manner described above from a primary vital signsdisplay screen. Upon accessing the set-up control menu 800, the NIBPmenu option would be highlighted to access the NIBP setup control menuand then a Smartcuf suboption (not shown) would be highlighted andselected. Under some conditions in which the artifact filter feature isenabled and motion artifacts are too severe that measurement accuracy isstill affected, the blood pressure measurement could be marked with anidentifiable symbol on the display screen and on printouts. Duringcertain types of arrhythmias and other situations in which a valid ECGsignal cannot be obtained, the motion artifact filter could also beselectively disabled by accessing the control menu in the same mannerdescribed above, highlighting the NIBP option and disabling the Smartcufsub-option.

The buttons of the user interface 96 and the display and/or backlight ofthe herein described monitoring device 20 can be locked out to preventunauthorized access or use. This lock out feature can be accomplished inseveral different ways. According to one technique and if the feature isinitially enabled using the PC configuration utility, the user cansimultaneously hold down the left arrow, the right arrow and the upbutton simultaneously for a continuous period of time (e.g., 5 seconds).All buttons, including the Power ON/Off button 56 are locked. Thebuttons are automatically unlocked when an alert or an alarm conditionoccurs. Similarly, the display 88 and/or backlight can also be lockedout by the user using a selective combination of buttons if no operatoractivity (e.g., no buttons are pressed) has occurred for a predeterminedamount of time. The backlight lockout and the display lockout featureswould again be disabled immediately after an alarm or alert conditionoccurs.

The remaining set up control menus that are available to the useraccording to this specific embodiment include that relating to the DemoMode (Disabled, Low, High). In addition to the set-up control menus, themonitoring device 20 incorporates additional control menus according tothis embodiment including a Device Status Control Menu; and a MessageControl Menu. The Device Status Control Menu permits the user to see adisplayed information screen 420(a), 420(b), such as shown in FIG. 26.The information screen 420(a), 420(b) includes separate panels 422, 424including the facility name, department name, and other associatedinformation. The Message Control Menu is used, for example, with regardto changing of ECG leads in the event of a lead failure, requiring thereassignment of channels. At the bottom of each of the control menus arecontext menu panels 416, allowing the user to navigate, the contextmenus for the set-up control menus being identical to those of theparameter control menus.

A more specific example of using a control menu is now herein describedwith reference to the display screen depicted in FIG. 22. In thisexample, it is desired to alter (i.e., raise) the SpO₂ lower alarm limitto 95 and to shut off the HR/PR tone. To perform the first step and with“SpO₂” highlighted, the down arrow button 100 is used to scroll tohighlight Lower Limit and the right arrow button 100 is then pressed asmany times as necessary in order to increment the limit to the intendedlimit value; in this instance 95. It should be pointed out the hereindescribed monitoring device 20 is programmed such that the upper alarmlimit cannot be decreased to a level that is lower than the lower alarmlimit for the parameter. Similarly, a lower alarm limit cannot be raisedto a level that is greater than or equal to the upper alarm limit.

To adjust the HR/PR tone, the down arrow button 100 is pressed to scrolldown to the HR/PR Tone field and the left or right arrow button ispressed as many times as is necessary in order to highlight OFF.Pressing the SELECT button or the display button 104 will exit thecontrol menu screen and return the display to the previous vital signsdisplay screen.

When the control menu is exited, the values that are displayed at thetime the menu is exited are the new default values for the monitoringdevice 20. If a parameter is changed therefore, a decision must be madeby the user prior to leaving the display screen whether or not to keepthe previous setting values. If so, these parameters must be returnedprior to exiting the control menu.

In summary and for purposes of menu and display navigation of the hereindescribed monitoring device 20, the directional arrow buttons 100 aretherefore used to perform any of the following functions: highlight anitem on display, selection of options from a control menu, set-up menuor displayed “pop-up” menu, and changing the values of numericparameters.

According to this embodiment, the display button 104 in addition tocycling though the configured display formats as shown in FIG. 19 canalso be used to return to a primary vital signs display screen from acontrol menu and for closing a “pop-up” menu.

Finally, the SELECT button 96 is used to perform the followingoperations: display the control menu for a primary highlighted item,return from a control menu to a primary vital signs display screen,provide access to a set up menu when setup is highlighted by the displaycursor, display of tabular and graphical trends when trends ishighlighted, display of snapshots when snapshot is highlighted, turn onthe display or the back light if either has been turned off by a powersave feature of the monitoring device 20, and displaying a pop-up menu.

The herein described monitoring device 20 in addition to displayingcurrent numerics and waveforms and the most recent measurements alsostores a predetermined amount of patient data. According to thisspecific embodiment, up to 24 hours (at one-minute intervals) of trends(graphical and/or numeric) information for the patient being monitoredcan be stored, as well as NIBP and SpO₂ “spot checks” and “snapshots”,as taken selectively by the user in connection with the patient andaccessible from the Trends option of the context menu of any controlmenu, as described below. When data storage is at capacity, the datafrom each new reading overwrites the data from the oldest data stored.The features relating to the taking of SpO₂ and NIBP spot checks havepreviously been discussed at length.

As previously noted, a snapshot request is made by pressing the snapshotbutton 116, FIG. 7, which is provided on the front facing side 84 of thedevice housing 24. Upon depression of the snapshots button 116, the CPU174 is programmed to provide a graphical display 298 of a defaultwaveform (ECG, respiration) for a selected lead for a predetermined timeperiod along with additional information, such as shown in the exemplarydisplay screen of FIG. 50. In the sample snapshot display screendepicted in FIG. 50 and according to this embodiment, for example, 21seconds of stored ECG data (7 seconds after the snapshot button 116 ispressed and 14 seconds before the snapshot button is pressed) ispresented along with a time and data stamp for each waveform, thewaveform source detected, the waveform scale (size) used and thecorresponding number of the snapshot. According to the presentembodiment, up to twenty (20) snapshots can be stored by the monitoringdevice 20 wherein any new snapshots overwrite the oldest stored versionsthereof. It should be readily apparent that the number of snapshots canbe suitably varied.

This data can be reviewed at the monitoring device 20. To review asnapshot and from any primary vital signs display screen, the userhighlights any of the parameter text identifiers (HR/PR, SpO₂, etc) andthen accesses a control menu for that parameter. The user thenhighlights the context menu panel 416 for that control menu and selectsthe snapshots option and confirms the selection by pressing the SELECTbutton 96. Highlighting the Snapshots option causes a Snapshots displayscreen to be displayed, examples of which is depicted in FIG. 51-53.Each of the up to twenty snapshots can then be viewed by the user. Inthe example shown in FIGS. 51-53, five (5) snapshots were taken. Thesnapshot display screen 590 includes a status panel 320 at the top ofthe display screen, a live numerics panel 356 and a snapshot displaypanel 594, respectively. The snapshot display panel 594 displays thestored snapshot for viewing and includes controls for selecting thesnapshot file, the data source, the scale of the display and scrollcontrols. A vertical line indicates the center of the display. Thewaveform and numeric vitals signs data during the 21 seconds can beviewed by the user by highlighting time interval provided at the bottomof the display screen 590 and using the directional (left/right) cursorbuttons 100 to scroll the display to the desired time. An example isshown in FIG. 52, for five seconds after the trigger point of thesnapshot as opposed to FIG. 51, which is taken one second following thetrigger point. The waveform source and size of the snapshot can also beselectively changed by the user for any captured snapshot byhighlighting the appropriate icon on the display screen and accessing anassociated drop-down menu 580, 600, as shown in FIG. 32, 33. In thisexample, the user can optionally switch to another type of display orcan exit and return to a primary vital signs display screen byhighlighting Snapshots in the upper left corner of the display screenand pressing the SELECT button 96. The preceding accesses a Trends menu640, FIG. 53, wherein highlighting the appropriate option allows theuser to navigate to another display screen.

As noted, the monitoring device 20 also stores trend data that isviewable in a plurality of user selectable formats. Trend data can bereviewed in a manner similar to that of waveform data by highlightingany parameter icon from any primary vitals signs display screen, FIG.53, and pressing the SELECT button 96. Highlighting Trends from theresulting pop-up menu and pressing the SELECT button 96 accesses theTrends display screen 470, an example of which is shown in FIG. 54. Thetrends display screen 470 displays tabular trend data as well as livenumerics for the monitored patient, the screen having a formatconsisting of a status panel 320, a trends live numerics panel 356 andtrends panel 474, respectively. The status panel 320 is similar to thatpreviously described with respect to FIG. 15 and the live numerics panelis similar to that depicted in FIG. 18. The trends panel 474 includes atabular listing taken at one minute intervals with current vital signreadings for the monitored patient at the top of the display screenabove the tabular list. As shown in this example, the reading time,HR/min, blood pressure (systolic/diastolic/mean), Respiration rate/min,and pulse oximeter (SpO₂) readings are provided. The user can scrollthrough the displayed tabular list using the directional (up/down)cursor buttons 100. The listing can include indications to show thosereadings that have already been captured in terms of snapshots, and anyreadings (if any) that are outside of permissible limits. Referring toFIG. 54, the user can selectively change the time interval for thedisplayed trend data by highlighting the Time text identifier 476 in thedisplay screen 470 and accessing a view interval “pop-up” menu 660,permitting the user to selectively change the time (e.g., 5 minutes, 15minutes, 30 minutes, 60 minutes) as needed by highlighting same andpressing the SELECT button 96.

FIG. 56 represents a sample display screen similar to FIG. 54, butindicating readings that have either exceeded alarm limits or appearsuspect.

When attached to the charging cradle 140 and the PC 192, as shown inFIG. 6, all captured snapshots are caused to be automatically printed,if the monitoring device 20 is on for subsequent printing by the printer195 through the USB data link with the PC 192 and the charging cradle140. The data is uploaded to the PC 192, either manually orautomatically through software loaded into the PC. According to the oneversion, all stored patient data is automatically printed when a poweredmonitoring device 20 is placed into a charging cradle 140. If themonitoring device 20 is off when placed in the charging cradle 140, thenthe autoprint feature is disabled. To enable the autoprint feature, theuser must power up the monitoring device 20 and select Continue Patientin the start-up display screen 400(b), FIG. 24. Tabular trend data andsnapshots stored within the monitoring device 20 are printed.

Pressing the Power On/Off button 56 accesses a Power Off display screenas shown in FIG. 47. The format of the Power-Off display screen 940includes a status panel 320, a notice panel 408, a short message panel412 and a context menu panel 416, as read from the top of the displayscreen. If there is an intent to monitor the same patient when themonitoring device 20 is turned on again, then it may be desired to savethe stored vitals signs data and monitoring device settings. As such,two options are provided in the context menu panel 416 at the bottom ofthe display screen 940—to either delete the stored data and settings andshut down or to save the stored data and shut down. Highlighting eitherof these options using the directional arrow buttons 100 and pressingthe SELECT button 96 will cause the monitoring device 20 to shut downand either save or delete the stored data and settings. Alternatively,if the Power Off button 56 is pressed and the user wishes to continuemonitoring the same patient, then a Cancel option is also provided inthe Context menu panel 416 of the display screen 940. Failure to actwithin a predetermined time period according to this embodiment, asmeasured by an internal timer, will revert the display screen 940 to theprevious screen or the default display screen as configured by themonitoring device 20.

Variations of the herein described monitoring device and associatedhardware and software are possible within the intended scope of theinventive concepts in accordance with the following claims.

What is claimed is:
 1. A multi-parametric vital signs monitoring system,comprising: a vital signs monitoring device, said monitoring deviceincluding a portable power supply enabling said monitoring device tooperate in a stand-alone mode and a wireless transceiver enabling saidmonitoring device to operate in an alternative wireless networked modewith at least one remote station; and a charging cradle adapted toreceive said vital signs monitoring device, said charging cradlepermitting said compact vital signs monitoring device to operate in apowered mode when said monitoring device is received by said chargingcradle, said monitoring device being operable in said networked modewhen said monitoring device is in said charging cradle.
 2. A system asrecited in claim 1, including a computing device connected to saidcharging cradle through a serial connection, said portable computerbeing configured to automatically receive stored patient-related datafrom said monitoring device when said monitoring device is attached tosaid charging cradle.
 3. A system as recited in claim 2, including aprinter connected to said computing device, said printer beingconfigured to automatically print stored patient-related data from saidmonitoring device when said monitoring device is attached to saidcharging cradle.
 4. A system as recited in claim 1, wherein saidcharging cradle includes a data port, said data port being engageablewith at least one peripheral device, the peripheral device being a largedisplay wherein data can be transmitted in real time to said display insaid third mode.
 5. A system as recited in claim 3, wherein said vitalsigns monitoring device includes a processor having memory and in whichsaid data port is connected with a computing device, said computingdevice and said monitoring device being configured for automaticallyprinting all data stored in said monitoring device when said monitoringdevice is attached to said charging cradle.
 6. A system as recited inclaim 5, wherein said vital signs monitoring device includes aselectively activated mechanism for capturing snapshots of patientrelated data, wherein stored snapshot data is automatically sent to thecomputing device for printing when said monitoring device is attached tosaid charging cradle.
 7. A system as recited in claim 3, wherein saidvital signs monitoring device stores patient data as trended data and inwhich said stored trended data is automatically sent to the computingdevice for printing by said printer when said monitoring device isattached to said charging cradle.
 8. A system as recited in claim 2,wherein said vital signs monitoring device includes a processor havingdefault settings for the operation of said device, said computing deviceincluding software for creating a configuration file that can bedownloaded to said vital signs monitoring device when said device isattached to said charging cradle, said configuration file including aset of selectable instructions that replace at least one of the defaultsettings of said device.
 9. A system as recited in claim 8, wherein saidvital signs monitoring device permits temporary configuring of at leastsome of the settings loaded by said configuration file or through theinitial default settings.
 10. A system as recited in claim 9, whereinthe vital signs monitoring device includes a user interface having a setof user actuable controls enabling the user to apply temporaryconfiguration settings to said monitoring device.
 11. A system asrecited in claim 1, including a remote station, said monitoring deviceand said remote station each including a wireless transceiver to enablebidirectional wireless communication therebetween.
 12. A system asrecited in claim 11, wherein said remote station is capable oftransmitting temporary configuration settings to said monitoring deviceby wireless communication.
 13. A system as recited in claim 1, whereinsaid vital signs monitoring device is patient wearable.
 14. A system asrecited in claim 8, wherein said configuration file includesinstructions for adjusting alarm limits of at least one monitoredparameter, said adjustment enabling a user to adjust the alarm limits bypredetermined percentage amounts.
 15. A system as recited in claim 14,wherein said monitoring device includes a user interface wherein aviolated alarm limit can be adjusted when the alarm has sounded using asingle button on said user interface.
 16. A system as recited in claim1, wherein said vital signs monitoring device continuously monitors atleast one physiologic parameter, said device including a pulse oximetersensor assembly in which said device permits continuous operation ofsaid at least one other parameter while enabling said pulse oximetersensor assembly to be run either continuously or for spot checking apatient.
 17. A device as recited in claim 1, including an ECG assembly,said ECG assembly including a pacer detection circuit for determiningpacer spikes.
 18. A device as recited in claim 17, wherein said ECGsensor assembly is configured to selectively determine an appropriateECO vector for noise detection.
 19. A device as recited in claim 10,wherein said user-actuable controls include a plurality of buttons thatare used with a display screen to navigate using drop-down menus thatare selectively accessible through the user interface.
 20. A device asrecited in claim 19, wherein said user-actuable controls include adisplay button enabling a user to toggle through multiple data displaymodes of said monitoring device.